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Monday, 18 June 2007
Page: 115


Mr ADAMS (8:17 PM) —The Aged Care Amendment (Residential Care) Bill 2007 was introduced into the House on 21 March this year. The Senate, on the recommendation of the Selection of Bills Committee, referred it to the Senate Standing Committee on Community Affairs. That committee reported on 17 May and made several recommendations. Labor believe that those recommendations should bring in some amendments to this bill, such as the omission of item 27, which repeals subsection 42-1(4) of the Aged Care Act 1997, and that the Department of Health and Ageing monitor the use of this subsection by aged-care facilities to ensure that it is used appropriately. We have major concerns with that item.

The bill repeals a provision entitled ‘high-dependency care leave’, which allowed more than one residential care subsidy when a resident has to move to another service temporarily—usually to a high-care facility. This provision existed under the resident classification scale—the RCS. Both the submitters and the department acknowledged that it is a little-used provision with fewer than 20 applications a year. The department’s evidence to the Senate committee also suggested that some applications on review may have been inappropriate. However, for a few small, often rural, facilities, the removal of the high-dependency care leave provision may have a significant financial impact, resulting in the potential for residents not being able to return. For this reason, Labor will move in the future to reinstate high-dependency care leave.

The Senate community affairs committee also recommended that the bill be amended to ensure that determinations made by the minister under items 28, 29 and 31 are reasonable and that a safeguard similar to that in section 44-4, which item 32 repeals, be implemented under the ACFI to determine a minimum lower basic subsidy level. In the move from the RCS to the ACFI, the provision to downgrade the basic subsidy by two levels cannot be transferred, due to the changed funding methodology. The bill proposes that the minister can determine the lower basic subsidy when a resident is receiving extensive care in hospital. The residential aged-care sector is nervous that the determination could result in a significant loss of funds. Labor is concerned that the minister may determine a reasonable level of reduced subsidy. The community affairs committee recommended that a review of the new Aged Care Funding Instrument be undertaken 18 months after implementation to assess the implications to all aged-care service providers and ensure that stated benefits are achieved. Labor will look for a formal review within 18 months of implementation of these provisions.

Despite this bill’s attempts to address a more flexible funding regime, there are big problems in the aged-care sector in my home state of Tasmania, and this bill gives me an opportunity to speak a little more broadly on the issues the bill is attempting to address. We have many aged and frail languishing in public hospital beds, causing blockages in the public health system. Funding for the aged-care facilities in many areas of my electorate of Lyons continues to fall, leaving many families with few, if any, options for the care of an elderly relative and, therefore, restricting access to nursing homes that would normally be glad to take them.

Some 3,000 nursing homes across Australia are at this time catering for over 160,000 people, with the demand for care increasing dramatically. It has been estimated that by 2019 there will be a need to provide care for some 970,000 people. This is a factor that the Howard government continues to refuse to recognise. Where do they think these people will be placed? They cannot stay at home, as the funding for home based care is insufficient to allow that to continue safely. Home based care programs are continually suffering from a severe lack of funding and an inability to get quality staff to carry out the care—though many people would rather stay at home under that sort of care. In many cases, families cannot care for their elderly parents or relatives because of other commitments on their time—for example, work and caring for children or a partner. What happened to the promise in 1997, when the Howard government made some pretty significant changes to the aged-care system which it predicted would guarantee positive outcomes for elderly Australians? Those changes never happened. The reforms never actually came into being, leaving a very large sector of the community still waiting to hear how their loved ones could be cared for.

Recurrent funding of aged care is high on the agenda for all providers. Maybe it is time to move to a funding model based on an accommodation component and a care component. It is suggested that there should be separation of these two cost drivers in residential aged care. This could possibly offer the public more flexibility, transparency and community understanding in this service delivery area.

One of the most difficult problems for providers is bed allocation. The application process is yet another failure of the Howard Liberal government. I have been approached on many occasions by providers seeking assistance with their applications. When I have asked the government for information and clarification of the issue, I have always been told that it is commercial-in-confidence or has to do with privacy. It is a competitive process, and it will probably stay that way. In many cases, it has cost providers a lot of money to put together an application. The money spent on the application process would, I am sure, have been better used if allocated to the operations of the residential care facility.

Planning for the care of the elderly appears to be an area of mystery and intrigue. On questioning about planning ratios, the response has always been, ‘That’s the way it was, so we just put it into place more formally.’ With an ever-changing demographic, along with improvements in the health status of older Australians, this area requires far more robust analysis. Aged care requires a well-trained and compassionate workforce. Over the past 10 years the shortage of nurses has become a significant issue, and this must be dealt with as quickly as possible. The number of nurses working in residential care has declined considerably while, at the same time, the community is calling for a diverse set of workers to respond to the individual needs of older people wherever they are living.

There are myths and incorrect assumptions about working in aged care. The allocation of additional undergraduate nursing places in the budget is of course welcome, but it is now our responsibility to ensure the recruitment of more nurses for the aged-care sector. There needs to be more encouragement of personal carers to adopt careers in aged care. The involvement of the medical and allied health professions in aged care is a goal that we all seem to want to achieve, but the barriers remain. There are access, funding and availability questions that must be addressed. Pay equity is an issue relative to not only nurses but also all aged-care workers. This should be addressed immediately. The conditional adjustment payment to 2007 is not of itself a sustainable solution.

Community expectations are growing very quickly. Families of residents of aged-care facilities and receivers of community care increasingly want to understand the type of care being provided. There will increasingly be an expectation that the staffing level and mix be known and understood by families of people who receive care.

Workforce issues present a challenge that can only be achieved through government and sectoral collaboration around funding, consumer education, training and education, career path development and national leadership. Labor will continue to hold the Howard government accountable for its failure to plan ahead and provide the type of detailed policies that are needed in aged care in particular. Planning for our built communities needs to take into account the overall ageing of the population. This needs to be kept in mind, with clever design and innovative ideas. This brings challenges to the building industry, town planners and governments, particularly local government, in delivering homes and communities that are suitable for the needs of an ageing population.

Some people are likely to choose lifestyle villages, whereas others may choose to stay in their own homes that have been modified with, for example, wider doorways and ramps, and some may need greater care. For those who choose to stay in their homes, there is the significant issue of social isolation. It is here that policy needs to be developed to prevent this isolation from becoming an epidemic in Australia. This isolation often develops because the person may have a disability or may have lost a partner or may have few transport options. Planning must take all of these circumstances into consideration in order to achieve cohesive communities. The importance of older Australians remaining involved in community life and remaining socially connected cannot be underestimated in their maintaining good health, both physically and mentally.