Mr ANDREN (4:16 PM) —It is interesting that I resume this debate on the Aged Care Amendment (Omnibus) Bill 1999 just after the matter of public importance debating the tax changes. Prior to question time today I was making the point that the former Commissioner of Taxation, Mr Trevor Boucher, pointed out recently that something like $21 billion is available in tax avoidance mechanisms in this country at the moment by way of offshore tax havens, minimisation pro grams and things such as negative gearing, which neither this government nor the one before seems to have been very interested in addressing during progressive tax reform rather than the regressive system that is about to be imposed upon us.

The point I make is that that sort of money could adequately fund our hospital and nursing home system without resorting to the user-pays principle in regard to nursing homes. I said also that it was in many respects a courageous act by the government—irrespective of the points about taxation—to take on board the challenge that Professor Bob Gregory's findings showed of a dramatic shortfall in aged care funding on the horizon in this country. And we do not have to repeat the statistics on the ageing profile and the need to address what is a crisis in this country.

We had the first round of aged care changes in 1997. I said at the time, and it was shown quite clearly, how poorly that process was implemented and the stop-start changes that had to be made. Firstly, we had accommodation bonds, then the family home under threat and we had a terrorised older population out in the community who were totally confused. It was such a pity that both the accommodation charge and the additional daily fees were implemented at the same time. I believe it could have been done in a staged process over several years. Notwithstanding that, we have had some very necessary changes, and I was and am prepared to support the user-who-can-pay principle.

This bill tidies up a lot of the remnants of that hastily introduced process and, according to the Minister for Aged Care, it ensures a range of resident protection measures for accommodation charges. The bill includes amendments that ensure that the rental now does not affect the pension and also the value of the family home does not affect the pension. It amends the Social Security Act and the Veterans' Entitlements Act to reflect those changes. It enables the rollover of bonds from hostels to homes. The explanatory memorandum refers to schedule 1, item 2 and to the Aged Care Act 1997 and states:

This Item repeals Subsection 10-3(2) which requires revocation of approved provider status not to take effect until alternative care has been arranged for all the care recipients.

One wonders what care would be provided in circumstances where the provider knows of the revoking of the provider status. We should ensure a close and ongoing supervision of those residents in such circumstances. There is nothing that I can see in the legislation in item 4, subsection 10-3(7) that convinces me that the interests of clients will be satisfactorily supervised during what would be obviously a period of incredible trauma.

I welcome the widening of the concessional definitions and the refund of accommodation charges for those in nursing homes at the point at which the original act came into being and who have subsequently moved on to another home. I welcome also that change from five years back to two years when the carer has had occupation of the family home. I welcome also the fact that no fees will be payable before a client actually accepts a place in a particular institution.

Looking more at the situation with regional nursing homes, particularly those in my electorate, I welcome the government's commitment to more multipurpose centre facilities, but I urge them to speed up this process. If there is one thing I have noticed in the state and federal health care area, it is that we have so many small country hospitals which are barely viable. They are clinging onto their state funded beds. They see the bed in itself as a symbol of the viability of the hospital and, therefore, their whole community. There is a real problem because of the rationalisation program that has occurred now over almost 20 years at a state level. People see any change in the status of their hospital as a threat to their very being. Of course, they have seen banks go and other changes occur in their communities, and they are not prepared to give up on the public hospital in that particular community. They are not prepared to give anything.

So we have a major problem in addressing this, particularly if we go down the multipurpose route, because we have to convince people that there is a demographic, socioeco nomic and age profile in these smaller communities which requires us as a federal parliament and administration to act in concert with the states and explain to people that hospital care, aged care and nursing home care are the responsibilities of both governments and that hospitals and medical facilities in towns have to change to reflect the needs of those communities.

I look again at the instance of the Yeoval Community Multipurpose Centre that was set up nearly 10 years ago after the former Greiner government threatened to close it down. Those residents and that community demonstrated. They lay down in front of the ambulances who were carting those elderly people off to nearby hospitals and said: `We are not going to let this facility close. We want our older people, particularly, to age and to die in their own community. We want access to those people.'

So grew out of a cooperative local effort the Yeoval Community Multipurpose Centre. That model has been picked up, but it is slow in its uptake around the country. It requires an urgent speeding up by this government and the state governments. There is not only Yeoval but Oberon is coming on stream as is Grenfell, outside my electorate. There are other country hospitals like Canowindra and Cudal where we have nursing home type patients ensconced in Nightingale type wards that were built earlier this century and that are certainly not fit for aged care accommodation.

The federal government has to accept responsibility for those aged people and quarantine, hive off and rebuild the nursing home component. It then has to convince the community before that process takes place that it is the older people who largely require the medical attention in these small communities. Country hospitals are de facto nursing homes in many cases. We need to tackle this issue particularly quickly.

The community care packages are also an area where we remember that 90 per cent of people choose to stay in their own homes. They choose to remain in their homes on country farms, in rural communities. They need these community care packages in far greater numbers than have been provided to date. I applaud the initiative of all of the ministers in this government who have been involved in these portfolios for the initiatives they have taken in this area, but we need far more.

I can remember my own mother choosing to stay in her own home and refusing community care because she didn't know enough about it; she hadn't been educated about it. Many people in that period 10 or 15 years ago could not understand why these people were coming into their homes, whether her purse of change would be safe and so on and so forth. She fought not only to stay in her own home but to die in her own home. There was no extended family, as is the case throughout this continent because kids are scattered to the four winds. We all sit at a distance, in guilt about our elderly parents deteriorating in their own homes when we know and they know that is where they want to be. With 90 per cent of people wanting to do that, that is where our focus should be in aged care. So much of the passion and so much of the rhetoric and so much of the scare campaign—so much of this whole process—has been directed in the last few years at institutional care. So little has been directed at the need to lift the quality of care of old people in their homes because that is where, in the main, they want to be.

It is interesting that after all of the drama and the angst and the concern and the fears that I waded my way through in the early stages of this reform process I am now getting few complaints from the aged care sector, except some doubts about the level playing field between hostels and nursing homes, who are competing for patients. Some of them feel they are being outmanoeuvred by the processes that are in place for the scrutiny of patients for placement in nursing homes. They do not feel that it is transparent enough and some feel they are missing out perhaps at the expense of others. That is one unfortunate consequence of competition in this area, I would suggest. The department needs to be vigilant in its scrutiny of the allocation of nursing home patients and the processes by which that is achieved. I do not want to be specific because I could draw attention to circumstances that could compromise particu lar organisations and individuals, but I have spoken to the minister's office about that and they are very well aware of the points I am making.

I am also concerned about the long term. The problems have not been identified long term by the nursing homes. I wonder whether the capital base, from the accommodation charges, that we are creating from this user-pays process is sufficient. There are conflicting estimates of the degree to which current user-pays and subsidy arrangements will meet the needs of the aged care sector down the track. But the opposition should not take comfort in this for one moment because Professor Bob Gregory in 1994 reported that it would take $125 million a year to bring the nursing home sector up to scratch. My argument is that we are not interested in the three- or five-star system that the Morans of this world may be talking about. I am interested in at least a one- or two-star system right across the board, because we patently have not had that. One has only to look at some of the reports on a couple of Tasmanian nursing homes a year or so ago to see that some of our older people have been living in appalling conditions.

The government believes that the $125 million a year will be raised by the fourth year of this reform process. However, the report of HESTA—the Health Employment Superannuation Trust of Australia—into the strategic capital needs of residential aged care between 1997 and 2003 suggests a $1.3 billion to $2 billion capital shortfall in capital requirements for nursing home funding. Why is there such a discrepancy between the figures? Even if they are exaggerating by 50 per cent, there is still a crisis looming, according to the HESTA report, irrespective of these reforms.

The Productivity Commission report into all of these begins to target some of these long-term problems. It does suggest that the `user who can pay' philosophy on its own will not be enough. The marketplace is not going to work because the clients of that marketplace will not be able to sustain the prices that the marketplace will demand. They will not be able to afford it for that 10 per cent going into institutional care.

I know the minister has read the Productivity Commission report, but she has not at this stage indicated when she will respond to it. I particularly refer the minister to the part relating to nursing homes in country areas or aged care funding. Recommendation 12 says:

Additional funding support for higher cost homes in special circumstances, such as smaller higher cost nursing homes in rural and remote areas, should come from a special needs funding pool.

That is a key recommendation of that report. It goes on:

The Government should add to current outlays to meet this purpose, separate from, and additional to, the funding of the basic subsidy.

There are many well-intentioned and well-targeted recommendations in that report, and I certainly will be listening with interest to the minister's response. This whole process of aged care reform has, I believe, underlined the need for more community care packages as the least expensive and most socially desirable aged care solution, along with that expansion in the regional and rural sense of the multipurpose health delivery models. So, with the reservations I have detailed, I commend this bill to the House.