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Wednesday, 13 May 1987
Page: 3128


Mr HODGES(6.42) —The Nursing Homes and Hostels Legislation Amendment Bill, of 45 clauses, is a most complex and important piece of legislation. I am just disappointed that this socialist Government and one of its more approachable Ministers, the Minister for Community Services (Mr Hurford), have been forced into the position this week of debating so soon a Bill of such magnitude. It affects the Nursing Homes Assistance Act, the Aged or Disability Persons Homes Act and the National Health Act and should have been given two or three weeks to lie on the table so that various nursing home operators and people involved in the industry could have been consulted and so that the Opposition could have had a little more time to examine its very complex content. The way in which this Bill is being dealt with is typical of the Hawke Government legislating on the run. The Minister would not or could not allow the debate to be delayed until the week after next. It is all very well for him to say that his predecessor had mooted certain changes and that reports have been prepared along these lines, but the cold hard fact of the matter is that we have had six days from the time the Bill was introduced last week to consider it and talk to nursing home operators. To deal with the matter in such a short time is an outrage to owners, to nursing home proprietors, to the elderly, to the sick elderly and to the relatives of people who occupy nursing homes.

The position in Australia in relation to providing nursing homes will reach a critical stage given the emphasis we are placing now on providing hostel beds. In the past there has been a maldistribution of nursing home beds throughout Australia, but much of this has been corrected by the operation of Commonwealth-State committees. If we consider some of the country towns and provincial cities in my State of Queensland, for instance, in a town to the west of Toowoomba it was accepted fact that if someone needed nursing home accommodation that person would have to go to Toowoomba or even Ipswich or Brisbane. Much of that problem has been overcome because of the concentrated effort to put homes into some of the smaller centres. It has not been possible to put them into all small centres, but certainly some of the larger centres have now been provided with these homes. I understand that this program is ongoing and the Community Services Department and the Government are to be commended for that.

About 57,000 beds are subsidised in the Government and participating homes area. That covers government nursing homes, private nursing homes for profit, religious and charitable nursing homes not for profit in what are classified as participating homes, and a fourth category of deficit-financed or non-profit homes operated by religious and charitable organisations. In that latter category of deficit-financed homes, 20,000 are subsidised.

I want to make some points about what I believe will be a serious shortage of beds in years to come. I understand the dilemma that the Government faces, because the recurrent cost of keeping these people in nursing homes causes grave concern. About $1.2 billion will be spent this financial year in subsidies to nursing homes. The Government will spend $56 million on providing new beds and quite a lot of that will go to hostel beds. That is where the emphasis is being placed now. At present, it costs about $50 daily in Queensland and Tasmania to keep nursing home patients and up to $70 a day in Victoria, with the Government subsidy being approximately $35 in Queensland and $55 in Victoria. The hostel bed subsidy is $1.95 a day, or $8.40 a day for the frail aged, and I understand that that will go up to $11 this month. I understand the thrust of the Government's approach, which is to provide more services, both hostel and in the community, to keep people in their own home environment through the home and community care program, or the HACC program as it is commonly known.

There is no scope today for private enterprise entrepreneurs to enter the nursing home business and the Government should consider the possibility of such business-on a non-subsidy basis. Unless a person can afford to pay between $300 and $500 a week to keep a patient in a home, such a person must rely on government subsidised nursing home accommodation. Perhaps in the future there will be scope for some scheme whereby people can take out insurance in their younger days to provide a bed in a home should they so desire as they enter the twilight years of their lives.

I want to warn the Minister and the Government in relation to care of the frail aged, a matter to which we give so much attention at present. It is true that more of those elderly people will end their days in hostels or in a home environment, but there will still be a considerable throughput of people in nursing homes, and that fact worries me deeply. Australia has a figure as high as any country in the world, per thousand of population, of people over 65 years of age who occupy nursing home beds. It is commonplace for Europeans and Asians to care for their elderly in the home environment. We have an aging population, and if we stop providing nursing home beds, as we have virtually done now, we will find after four or five years an enormous backlog that eventually will have to be faced. We will have to catch up.

Let me turn to some of the main provisions of the Bill. The Minister, in his second reading speech, mentioned nursing and personal care costs that will be looked at in the future. I applaud him for the attempt to bring some uniformity of payment in this area of government subsidy to nursing homes. But he has not addressed the varying costs of staffing under different awards in the various States, which is a major problem. What he has done is address his attention to the infrastructure costs-those costs associated with cleaning, laundry and food-and that very important component for a private nursing home operator, the return on the investment.

The cost of operating a home in Perth, Darwin, Mount Isa, Brisbane, Melbourne, Hobart or any other city in Australia will vary considerably. If one were to set out to build a new home in any of those centres, one would find that the building and land component costs would vary considerably. I ask the Minister whether he has considered economies of scale in setting his standard aggregate module that he has designated. There is no doubt that if one were operating a home of 100 beds, the economies of scale would be such that a competitor down the road operating a home with 35 beds would be at a disadvantage. In any case, it is not possible to put large homes in all of the centres. As I pointed out earlier there are a number of small cities and towns where nursing homes operate and in which it is not possible to have large numbers of people in the 60-plus age group.

I ask the Minister to give some attention to and to tell me what the operators of these homes can expect if operators right around the nation are to receive this same level of $27.65 per occupied bed day in the first financial year that this new scheme will operate, with the extra $6 for the extensive care patient. The Minister tells us that 65 per cent of the homes are below the SAM level and therefore they will get more subsidy, and that 35 per cent of them are above the SAM and therefore will get less subsidy. There will be some winners and some losers in that. What I cannot reconcile is that, when wages and food costs vary considerably around the nation, operators will be expected to operate nursing homes, whether for profit or otherwise, receiving the same subsidy.

Even on a State by State basis there will be grave difficulties. To expect someone to operate a nursing home in Mount Isa, Cairns or Darwin with the same subsidy as for those in Brisbane, Perth or Sydney is quite absurd. I would like the Minister to tell us how it will work. If we take average weekly earnings as a guide-after all, that flows on into many costs, quite apart from the costs for nursing and personal care that the Minister will address at some future date-we find that in Queensland average weekly earnings as at August 1986 were $350.70. The figure for the Northern Territory at the top end of the scale was $435.40, with the other States in between. That means the average weekly earnings in New South Wales are 10 per cent or $34.70 a week higher than in Queensland. It means that average weekly earnings in Victoria are 7 per cent or $24.10 a week higher than in Queensland.

I have obtained from the Australian Bureau of Statistics the average retail price figures of 13 food items for the December quarter 1986. The food items are milk, butter, bread, flour, boneless rib beef, sausages, leg of lamb, chicken, potatoes, tomatoes, carrots, eggs and tea-not a comprehensive list but a cross-section of common food items that one would expect to be used in any nursing home. When I added up for the common quantity of those 13 items, I found that they could be purchased cheapest in Perth at $27.47, with the most expensive being the Northern Territory at a price of $32.17-a 15 per cent difference between the bottom figure in Perth and the top in the Northern Territory. I ask the Minister how people can operate homes when there is that sort of variance and when they are to be paid a common figure across the nation.

Let us look at similar sorts of figures within a State. Let us take the weighted average of eight capital cities, with the mean figure at 100. Sydney is 99, Albury is 107, Bega is 114, Broken Hill is 113, Cessnock is 101, Deniliquin is 108 and Griffith 106. That is just a bit of a cross-section of New South Wales. But those figures vary up to 8, 10 or 14 per cent; some are even higher.

I turn to Victoria, which is probably that State with the least variation. Melbourne is 101, Bairnsdale 103, Castlemaine 106, Portland 106 and Swan Hill 104. But they are still considerable percentages. In my State of Queensland Brisbane is 98, Ayr is 111, Bowen 114, Cairns 107, Dalby 105, Gympie 104, Mount Isa 111, Rockhampton 105, Roma 111 and Thursday Island 157. It costs 57 per cent more to run a home on Thursday Island. I admit that that is an extreme case, but I would like the Minister to answer how proprietors can be expected to run homes throughout Australia with a common subsidy.

Today I spoke to one nursing home proprietor-of a deficit financed home, I add-of a home with 65 beds who told me that in four years he has had a turnover of about 400 people through his nursing home. Sixty-three of his patients are extensive care patients and two are ordinary care patients. The Minister, in his second reading speech, made reference to the fact that a number of people should be returned to the community. I would not quarrel with the suggestion that, if a person's health has improved and he has been rehabilitated, he ought to go back into the community. That ought to be constantly under the attention of the proprietors. But the proprietor to whom I spoke told me that only one of those 400-odd patients has gone back into the community, and only four back to hostel accommodation, in that four-year period.

I also ask the Minister to address the fact that a number of these homes have young disabled people in them. I understand there are six at present in the home to which I have referred. What will happen to those people? Will those beds be categorised separately? The Minister makes reference in his second reading speech to 69 homes primarily providing accommodation for disabled people under 70 years of age. No doubt there are proprietors all around the nation who have one or more young disabled patients. That point ought to be clarified by the Minister.

I want to refer to a few words in the Minister's second reading speech because I think they emphasise the rather critical shortage of nursing home beds in this nation, certainly in some parts of it. The Minister refers to the fact that the Minister has the right to withdraw a Commonwealth benefit if the home fails to bring its standard of accommodation up to a certain level. The second reading speech states:

The principal existing sanction currently available to the Commonwealth is to withdraw approval of the nursing home, but applying this is difficult because of the immediate need to find alternative care for a large group of frail aged residents if a home is closed.

The point is well taken. Even if the home was in a large community with several hundred other beds, there would be difficulty in closing down an old nursing home, even if it had only 30 or 40 beds. What would happen to those residents? There is a very real problem. The Minister's words underline the fact that a critical situation exists in many areas. Most of the nursing homes in my electorate have waiting lists as long as my arm. Often it is very difficult for relatives to get their aged and ill aged admitted.

In another part of the second reading speech, the Minister referred to the fact that certain standards are to be gazetted. I ask the Minister to respond by answering whether they have been gazetted. If not, when does he expect them to be gazetted? Is there any mechanism of appeal for nursing home operators if they fail to bring their home up to the standards that the Department will require? It does not appear to me that there is an appeal mechanism. I am aware that the Minister referred to the nursing home standards review panel in each State. Does the Government intend to legislate for that, because it talks about a pilot panel to start with? I ask the Minister to respond to those questions. In conclusion, I wish to refer to the Aged or Disabled Persons Homes Act 1954.


Mr DEPUTY SPEAKER (Mr Leo McLeay) —Order! The honourable member's time has expired.