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Thursday, 14 May 1987
Page: 3159


Mr CONQUEST(9.47) —I welcome any measure to improve the quality of care and quality of life provided for the aged which at the same time achieves greater efficiency in government funding of nursing homes. I recognise that in the existing system recurrent funding impacts directly on the aged in that there can be a variation between the standard fee and the approved fee. Where the latter is more than the standard fee, it is the aged patient who makes up the difference by way of an increase in his or her contribution or, in some cases, the caring relatives make up the difference. The fees of nursing homes have been controlled by the Commonwealth since 1 January 1973 and at present are related to the cost structure of each individual nursing home. Patients in these homes are required to make a contribution towards the cost of their accommodation. The statutory minimum contribution is currently equivalent to 87.5 per cent of the maximum single rate pension plus supplementary assistance.

The Commonwealth pays benefits on behalf of all qualified nursing home patients who are accommodated in nursing homes approved under the National Health Act. The basic benefit varies from State to State and is reviewed annually. In reviewing basic benefits each year the principle adopted by the Commonwealth has been that benefits be set at a level in each State which, together with the statutory minimum patient contribution, covers fees charged for 70 per cent of beds in the State in non-government nursing homes approved under the National Health Act. The current level in my State of Queensland of $35.25 per day, plus minimum patient contribution, would meet the fees charged in respect of 77 per cent of the total number of non-government National Health Act approved beds as at February 1986.

The Commonwealth presently has a role in the area of nursing home care related to the provision of health benefits and other financial assistance. To ensure proper controls over the provision of this assistance, the Commonwealth has provided in its legislation for admission control and growth control, in addition to fees control in participating nursing homes, and budgetary control in deficit financed homes. State governments have the prime responsibility for licensing, determining and supervising the maintenance of standards for nursing homes in individual States. Of course, there are three types of nursing homes, which are subject to legislation, for which the Commonwealth Department of Community Services has responsibility. They are: The non-government nursing homes approved under the National Health Act known as participating nursing homes; those State government nursing homes approved under the National Health Act; and nursing homes approved under the Nursing Homes Assistance Act conducted by charitable and benevolent organisations or local government bodies, and which are currently deficit funded. The approval of these homes under the respective legislation is subject to various conditions, which are specified on the certificate of approval issued to the nursing home.

I am pleased to see that under the new arrangements the Commonwealth will fund a specified level of service of nursing home care at a predetermined price. However, I am greatly interested in the means by which the price is calculated. I have long wondered at the variation in nursing home benefits paid to the various States. The fact that Victoria's benefit is presently at $54.60 a day while Queensland's is only $35.25 demonstrates a remarkable disparity. I certainly agree with the comments of the Minister for Community Services (Mr Hurford) in his second reading speech, when he said:

Cost savings by efficient nursing homes proprietors do not produce increased profits and there is, therefore, no incentive to operate efficiently.

That is very important and we must examine the new scheme to ensure that it will not entrench and even encourage new inefficiencies.

The per capita inequities in benefits paid to the various States have been attributed to the variation in costs. I am not sure how costs can be changed by the mere passage of legislation. The fact that in the period 1973-85 the increase in Commonwealth per bed day expenditure was 60 per cent, compared with a 233 per cent increase in the consumer price index and a 308 per cent movement in average weekly earnings, means what? To say the cost of nursing home care has risen out of all proportion to other indicators seems to imply that goods and services which affect nursing home costs are represented by the basket of goods and services used in the consumer price index calculations. Does it mean that movements in their costs necessarily follow these other indicators? I see no reason for accepting such universal application.

I do appreciate that the huge disparity in nursing home benefit payments between the low cost State of Queensland and the high cost State of Victoria could be, as the Minister alluded to in his second reading speech, unscrupulous proprietors exploiting the system to increase profits at the expense of residents and taxpayers. It is possible that a uniformly applied benefit rate may harm those nursing homes where costs, for justifiable reasons, are higher than the predetermined level? If so, what is to become of them?

I do note that in response to requests from industry organisations, the Government has agreed to regular reviews of the appropriateness of the level of the standard aggregated module based on surveys of industry costs. Movement in the composite infrastructure costs, embodied in the standard aggregated module, which comprises transport, laundry, food and so on, maybe adequately represented by a formula involving movements in average weekly earnings and consumer price index indices. However, in the other cost component area, namely, those costs related to direct nursing and personal care, I still maintain that the consumer price index and average weekly earnings are not necessarily accurate or suitable indicators. I repeat this because both components, that is, care costs and infrastructure costs, make up the total bed day costs about which the Minister expresses concern because of their variance to consumer price index and average weekly earnings movements.

Because the Nursing Homes and Hostels Legislation Amendment Bill is seeking to redress the interstate inequities, indeed inequities between individual homes insofar as funding is concerned, I strongly support it. As a Queensland National Party member, I am frequently in contact with the administrators of nursing homes in my electorate of Hinkler and I am always greatly impressed with the dedication of all involved in the caring process-staff and committee and the wonderful people in the communities who support them. I am also frequently reminded that there is still a greater need for nursing home care in the electorate. Of course, the fact that Queensland's nursing home benefit costs are the lowest in the Country, would seem to augur well for those existing homes. They should be able to utilise that funding over the transition period which is above the predetermined standard aggregated module level, by using it to improve even further the quality of care they offer their patients.

The term `resident classification system' conjures up in my mind a situation where a home reports in with a roll call of 20 type A patients, 14 type B and so on. It is my hope that such an impersonalised system will not be incorporated at the expense of compassion and other related factors. I can see the reason for doing it but I repeat that I hope the bureaucrats and others involved in the process never lose sight of the fact that they are dealing with human beings.

I note the consultative process undertaken by the Minister and his predecessor in the formulation of the Nursing Homes and Hostels Legislation Amendment Bill, and I also note the measures taken to prevent corners being cut in the standard of care of nursing home residents with the introduction of the standard grant arrangements. The clarification of care standards required in nursing homes has been quantified in a document which incorporated extensive contributions from service providers, unions and professional groups, consumer bodies and many others.

The introduction of measures to ensure that the minority of homes that have a record of providing poor quality care are discouraged from such a course of action concerns me somewhat. The withholding of funds for new residents admitted and the withholding of infrastructure spending surplus income surely impacts on the aged, whom we are all trying to assist. While all this withholding is going on, what is happening to the residents of the homes? Disincentives to the proprietors are all very well but they may also encourage a further deterioration of the already poor standard of care so that they can maintain a particular level of profitability. It may not be a permanent position but I would ask the Minister to have another look at this matter.

Where a Minister exercises the right to reassess a resident's need for nursing care and finds that he or she no longer needs such nursing care, I trust the statement made by the Minister in his second reading speech can be taken literally. He said:

Where it is found that a resident no longer requires nursing home care he or she will be counselled and given every assistance to find the necessary appropriate accommodation and support services.

I was under the impression the validity of approved applications for admission was already limited to 90 days, and that a further nh5 form was needed to be completed by the applicant's doctor. I would appreciate clarification on that point.

In conclusion, I would like to complement the Minister for tackling such a complex issue and I would hope that if and when any problems emerge in the practical application of this legislation, speedy resolution, tempered with compassion, will be the order of the day.

Motion (by Mr Humphreys) agreed to:

That the question be now put.

Original question resolved in the affirmative.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.