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Thursday, 14 May 1987
Page: 3153


Mr IAN ROBINSON(9.12) —I rise to speak on the Nursing Homes and Hostels Legislation Amendment Bill, which is one of the most important pieces of legislation this session. There is no more vital need in the community today than that of nursing home care for the aged. I take this first opportunity to congratulate the Minister for Community Services (Mr Hurford), who is at the table, on his appointment as Minister for Community Services. I wish him well in this important field of administration in the Commonwealth of Australia. Since the early 1950s it has been a tradition that the Federal Government has encouraged, financed and administered services for the care of the aged through capital funding and maintenance funding for facilities in the field of nursing homes, hostels and other services for the aged. Of course, during this time there has been an enormous growth in need brought about by the transition of an aging population in this nation.

I listened with some bewilderment to the honourable member for Capricornia (Mr Wright). He heaped scorn on past administrations for what was done in this field. I think he knows very little about it; it reflects upon his capacity and understanding of the field that he made the comments that he made this morning. The fact is that over the last three decades there has been a fairly bipartisan approach in this field. I hope that that will continue in the future.

However, there are important issues that do impinge upon the political considerations. They relate to the requirements of the Federal Gov- ernment in respect of the administration of nur-sing homes, the initial approvals of nursing homes and the allocation of beds, including the right to construct additional facilities in the category of either community or private nursing homes. For a very long time, since the inception of this scheme under the Menzies Government in the early 1950s, there was never a question about seeking a bed allocation. It was merely a matter of local communities being able to assemble enough contribution towards the cost of the capi-tal construction of a nursing home, and it was virtually automatic that Federal assistance would then be available. There was not even a waiting list. The funds provided by the Federal Government virtually ran ahead of the community's capacity to provide its share. This changed, and it changed dramatically as a result of the demand that generally grew because of an aging population. Quite understandably, there then had to be some measures to deal with that situation. It then became obvious that there was not an unlimited pool of funds for capital purposes and for maintenance purposes. Quite understandably, there has to be guidelines and consideration had to be given to how to administer them from that day on.

I believe that past governments and the present Government have tackled this situation objectively. However, we must beware that the bureaucrat does not take charge to the extent that the local community's participation is in any way moderated. I urge the Minister, who is at the table, to give special consideration to that aspect because the raising of local funds for community nursing homes is a vital element. Without it, no government could ever have provided the services in the field of nursing homes which have been provided over the years. We can think of all the small community nursing homes throughout this nation. We can think of those that are under the umbrella of important organisations, such as the St Vincent de Paul Society and its sister community organisations within the Catholic Church. We can think of homes for the aged under the umbrella of the Frank Whiddon Masonic Homes of New South Wales. This organisation is interested in the care of those in the community who are less fortunate. There are many others throughout this nation. Collectively, the funds that have been raised, administered and put to use in the interests of the aged in the last 30 years from these sources have been of enormous value in providing the services that we now have. Before the Government entered the field, some of these organisations were the forerunners in providing services of the sort that are needed today.

More recently, nursing homes have been provided through the private sector. Again, without the contribution from and enterprise of those who have been prepared to construct, through raising the capital nursing homes of a standard that is equal to any in the world, today we would not have the capacity to care for our aged as we are doing.

This legislation deals with some administrative matters. They are important. In recent weeks there have been problems in relation to the maintenance funding of nursing homes and delays in the payment of funds. I have taken up this matter with the Minister in respect of organisations in my electorate. He has responded, and I know that he is concerned that local organisations cannot carry the amount of funding necessary for maintenance purposes for up to six, eight or 10 weeks. The amounts involved are too large for local organisations to carry for such periods. I hope that some of the measures contained in this legislation will assist in overcoming those delays.

It is recognised since the McLeay report of, I think, four years ago that there is a real problem in meeting the needs. So the emphasis is on the way in which bed allocations are made and how to recognise the need in each locality that wishes to establish a nursing home. The present Government, in the early stages of its administration, established a State-Commonwealth co-ordinating committee to set the priorities for the allocation of beds for nursing homes which, as I said earlier, really means licensing for the construction of a nursing home and setting the number of beds that will be available in each community. this has led to some complexities in communities where there was an on-going support, through public fund raising, for the provision of additional capacity through nursing homes.

The complexities arise from a rather rigid bureaucratic approach, an approach based entirely on statistics within the community. It may seem to make sense to those sitting behind a desk administering the scheme, but there are many considerations in the community which must be taken into account, such as the distance from the community of need. In northern New South Wales, the ageing population is located mainly along the seaboard. People have moved from the metropolitan areas to that part of the State for their retirement. The statistics, even the age groups, do not give the whole picture. We must consider the question of people having to travel from residential areas to the location of the new facilities. When someone is admitted to a nursing home, obviously there is a family link; there is a wife or a husband, sons and daughters. They must have access so they can provide through their regular visits, that important care that goes hand in hand with nursing home care. There is a great need for the Minister to consider that element within the activities of the co-ordinating committees which provides an effective link with local communities. Perhaps there could be a representative in each zone; someone who is not merely an official of a State health department who does not have direct links with the community or the time to go around and talk to local committees, local officials and local people who are concerned with the care of the aged.

We know that there is great competition on the part of organisations for additional space through the extension of their nursing home or the creation of a new one. Those proposals cannot receive funding straight away; there must be priorities. We understand the difficulties that confront us in this area, but we must press on. I deplore the comments of the honourable member for Capricornia who asserted that there has been a huge increase in capital funding. We know that that is not the case. When we consider the construction costs of buildings in terms of the consumer price index we see that there is a real dilemma regarding capital funding for the extension of nursing home facilities. We must do the best with what we have. We must find our way through these real challenges. I wish the Minister well in that regard.

A further element that came primarily from the McLeay report was that we should place more emphasis on home care, on keeping people in their own homes for as long as possible. That concept is strongly supported throughout the community. There is an understanding of that very vital approach in the care of the aged. Much more needs to be done. Home services are slowly increasing in all communities, but there is a long way to go. The provisions of this legislation, I hope, will give further impetus in that direction.

We must be aware of the other frustration that exists in this legislation. I refer to the system that will determine the right of entry into a nursing home. Earlier I spoke about the operation of the State-Commonwealth co-ordinating committee on the allocation of beds and the approval for extensions to or the construction of new homes. Virtually the same considerations that I mentioned earlier in that respect must apply to the administration that is set up or amended as a result of this legislation in relation to approval for admission of a person to a nursing home. There are many considerations. Health, on the basis of a medical report alone, is not enough; there are other considerations. We do not want to see people occupying beds when they do not need them, but on the other hand we do not want to see people left high and dry because the right of entry into a nursing home is too rigidly controlled.

Aged people encounter many problems, and health is basic to those problems. At all times they need the kind of lift that can come only by ensuring that they are encouraged, not discouraged. Very often encouragement comes from local service organisations and from families, where family support is adequate. But on many occasions that is not so. Lonely people who are aged and who do not have close relatives but perhaps have a close friend may find it hard to cope. The doctor may say: `Perhaps you should consider going into a nursing home'. That is the last thing such people want to do. They are worried, concerned and apprehensive. A rigid approach to testing their eligibility can impose even greater strains upon them. This is a sensitive area and it needs to be transmitted from legislation to implementation and administration with a great deal of sympathy and understanding. I am sure the Minister will not overlook that in the implementation of the regulatory requirements of this legislation. In the time scale available it is not possible for me to cover a number of other important aspects of nursing homes. I say in conclusion that we must encourage as far as possible, and without impinging too heavily on the public purse, the facilities that are so vital to meet the needs of the growing numbers of aged people in our community.