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Wednesday, 13 May 1987
Page: 3126


Ms JAKOBSEN(6.28) —I am pleased to follow the honourable member for Lyne (Mr Cowan) in this debate on the Nursing Homes and Hostels Legislation Amendment Bill as he has the name of my seat.


Mr McGauran —Give him more time, then.


Ms JAKOBSEN —I will not give him more time. I have a couple of things to say on this Bill. I would like to bring up the point made by the honourable member for Lowe (Mr Maher) about the comments of the honourable member for Barker (Mr Porter). The honourable member for Barker intimated that care for the aged should be handed over to the States. He did not actually say so explicitly but he intimated it. He was commenting on the disproportionate amount of Commonwealth involvement and regulation in aged care and child care. I also understood him to say that inspections of nursing homes could be left to local authorities. I would not be supportive of any such delegation of responsibility, as I believe that as members of Federal Parliament we owe it to the elderly in the community and their families to ensure that the elderly are properly cared for in nursing homes and hostels. I do not believe that we can delegate that responsibility.

Further to the comments of the honourable member for Lyne about keeping the family together, I think that the Government would agree that that is a desirable way to handle these matters. That is why the Government has brought into effect the home and community care program in this country. However, it is a sad reality that most families in Australia are nuclear families. Often, for reasons of distance or work, various members of a family tend to live in different locations; therefore often elderly people have to be looked after in nursing homes. The need for nursing homes is a sad fact of life and it is something with which the Government must come to grips.

My colleague the honourable member for Lowe said, quite rightly, that every member of this House should have an interest in the matter of the provision of nursing homes. Almost all of us would have at least one nursing home in our electorates-although I exempt members representing country electorates, because they are not so fortunate. A number of nursing homes are located within my electorate of Cowan, including one in Warwick run by the Church of Christ and another called the Villa Terrenzio, which is run for elderly people of Italian origin. On the subject of ethnic aged, I point out that the Nursing Homes and Hostels Review, tabled in April last year, made special mention of the needs of the ethnic aged. I think that the guidelines suggested for such specialist nursing homes are still valid today. It is an area in relation to which we will have to take a great deal more action. I am sure that the Government and the Minister realise that. The Nursing Homes and Hostels review states:

The Government has established a number of guidelines for the assessment of applications for nursing home accommodation for the ethnic aged, and these are in accordance with the recommendations of the McLeay and Giles reports. In summary, the objectives are to:

Ensure adequate and equitable provision within the overall objectives of moderating nursing home provision.

Encourage appropriate alternatives to institutional care for all community groups.

Address the problems of the past whereby access to general aged care services has been difficult and accessed services have often proved unable to meet special needs.

Encourage some specialisation of provision while recognising that the range of ethnic groups, and their wide dispersion, make it difficult for the Commonwealth to meet all demands for ethno-specific accommodation.

I am especially concerned about the welfare of ethnic aged people, as I am sure other members of this House are. This is particularly in view of the fact that as people get older they might lose any ability to speak English as a second language. It seems that senile dementia and some of the other problems experienced by people of ethnic origin does affect their ability to speak English, if indeed they have learnt to speak it at all during their time spent here. I accept that, although ethnic groups, per se, tend to have a better record than do Anglo-Celtic Australians in terms of looking after their elderly people in their own homes, this will now become more of a problem to them. I have spoken to some Macedonians who live in my electorate and they are very concerned that, although to this stage they have looked after their elderly people, they will require nursing homes in the future. They do not have quite the same need for hostel care because they look after their elderly for a longer time than do we Anglo-Celtic people.

Contrary also to the claims made by the honourable member for Barker, this Nursing Homes and Hostels Legislation Amendment Bill 1987 is aimed at achieving greater efficiency in the nursing homes and hostels area, while ensuring uniformity of standards and an improved quality of care and quality of life for aged people. The Bill will amend the National Health Act 1953 and the Nursing Homes Assistance Act 1974 in relation to the introduction of new financial arrangements for nursing homes to commence on 1 July 1987. The Bill will also provide a mechanism for setting the standards of nursing home care to be provided in nursing homes approved under the National Health Act 1953. I think that the standard of care and the uniformity of care is a most important aspect of the Bill, as, of course, is the uniformity of payment on the part of the Commonwealth.

The Bill will amend the Nursing Homes Assistance Act 1974 so that it applies only to nursing homes where the majority of the patients are disabled persons who are less than 70 years of age. All other nursing homes approved under that Act will have their approvals transferred to the National Health Act 1953. Importantly, the Bill also will amend the National Health Act 1953 to provide for the payment of nursing home benefits to the proprietor of a home whose approval has been transferred to that Act, in respect of nursing home patients in the home. The Bill will also introduce new funding arrangements and provide a new method of determining the fees both for nursing homes currently approved under the Act-other than government nursing homes for disabled people-and for transferred homes. It will provide a mechanism for establishing the standards of nursing home care to be provided in approved nursing homes and it will give the Minister new powers to deal with cases of non-compliance with these standards. I think that that is a particularly important aspect of the Bill.

The Bill will prevent nursing home proprietors from charging admission fees or soliciting other financial assistance in respect of the admission of persons to a nursing home. I am sure that all honourable members of this House would be aware that these types of practices have occurred. I do not believe that that is a good thing to allow to occur in our society; neither does the Minister and neither does the Government, and that is why this provision has been put in the Bill. The Bill will introduce a time limit of 42 days from the date of notification to the proprietor of a decision setting a scale of fees for a nursing home for the proprietor to request a review of that decision. It will also provide a mechanism to enable the Minister to approve the demolition and reconstruction of nursing home premises. As honourable members would realise, that is a very desirable provision also, because it does mean that we can upgrade the facilities that exist in certain nursing homes in relation to which there might not otherwise be any facility to do so.

The Government will pay a Commonwealth benefit in relation to a nursing home patient, dependent upon the patient being an approved patient. Further, the Bill will enable the Minister to declare in certain specific, and I am sure limited, circumstances that a nursing home patient no longer needs nursing care. The Bill will rationalise the admission and emergency admission procedures under the Act and it will make other minor amendments. Furthermore, the Bill will amend the Aged or Disabled Persons Homes Act 1954 to enable the current value of donated land and other land acquired by an eligible organisation to be used in connection with an approved home under that Act to be counted as part of the matching funds of the organisation when calculating capital subsidy. I believe that this is an important clause in the Bill, as it does mean that those people who have land available and who wish to open a nursing home-and this applies especially in some senses to people in the ethnic communities, because they often have social responsibilities in a certain area-will be able to have a nursing home in the area of their choice. So, I think that this inclusion of land in the calculation of capital subsidies is a very important aspect of the legislation.

The Government acknowledges that the achievement of improved care services for the aged depends very much on the co-operation and support of the community, the nursing home industry, and other groups. Accordingly, the Commonwealth has undertaken extensive consultations on the proposed changes with State governments, nursing homes and hostels representatives, consumer and welfare groups as well as other professional and staff organisations. I congratulate the Minister for Community Services (Mr Hurford), who is at the table, on that endeavour.

The reform comprises the two major elements that have been discussed throughout the debate, including the funding arrangements. Under these arrangements the Commonwealth will fund a specified level of service of nursing home care on behalf of residents and at a pre-determined price. It will no longer reimburse proprietors for whatever level of cost has been incurred. This arrangement is similar to that which has been entered into by the Commonwealth in relation to child care operating costs, although this involves capital costs as well. I think that that is a very important factor, as such a differential has previously existed in the provision of care and the cost of care across the States and between States. For instance, at present residents of nursing homes are confronted with unexpected fee increases every few months. The Minister wants to ensure that in future family members arranging accommodation for elderly persons in a nursing home will have some idea of what the fee will be. Many residents are required to pay amounts which are far above the minimum contribution, even though the standard of care may be no better than that provided in other nursing homes where the minimum contribution applies. Accountability is an extremely important aspect of the Bill. Furthermore, under the present arrangements cost savings by efficient nursing home proprietors do not produce increased profits and there is therefore no incentive to operate efficiently. Members opposite should consider that factor very carefully when they come to vote on the Bill.

Commonwealth nursing home benefits are geared to the levels of expenditure incurred by nursing homes. Because costs vary widely between homes and States, this system has led to substantial per capita inequities in benefits paid in one State as against another, as I said earlier. Different funding and funding control mechanisms have not been able to contain the mushrooming costs of nursing home accommodation and have resulted in totally unacceptable and unjustified cost escalation. The funding system itself appears to be at fault and is therefore the aspect that requires change designed to provide for greater incentives for efficient operation.

I refer honourable members to the Nursing Homes and Hostels Review, which contains a relevant report relating to the respective position of the States. That is an important aspect because the Commonwealth Government must not have differing costs across the country and differing expectations of the Commonwealth's being able to meet those costs, especially when the standard of care is so un-universal. The purpose of the legislation, then, is to provide a reasonable arrangement for funding. I congratulate the Minister for introducing the legislation, and commend it to the House.