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Wednesday, 20 June 2007
Page: 56


Mr BRENDAN O’CONNOR (12:36 PM) —I rise to support the amendments to be proposed by the shadow minister for ageing, disabilities and carers to the Aged Care Amendment (Residential Care) Bill 2007. I would like to associate myself with some of the comments made by the member for Hindmarsh. I saw at close quarters how important the aged-care issue is to him: when he was a candidate, prior to the last election, he was very involved in discussing concerns with residents, staff and operators of aged-care centres in his electorate. Following his election, after his third effort, he has shown that he has not forgotten those concerns and is continuing to raise those matters now that he is the member for Hindmarsh.

I indicate to the House that the Labor Party supports in principle the thrust of the bill, but a number of amendments could be made that would improve the policy if the bill were to be enacted. The Senate Standing Committee on Community Affairs, having considered the matter on 7 May this year, made a number of recommendations to the parliament which I believe the government should consider adopting. Some or all of those recommendations were incorporated into the amendments proposed by the shadow minister.

We would argue that the bill would be improved if it were amended to omit item 27, repealing subsection 42-1 of the Aged Care Act 1007, and that the Department of Health and Ageing should monitor the use of this subsection by aged-care facilities to ensure that it is used appropriately. That is why we propose to move to reinstate the term ‘high dependency care leave’. There is a concern that the repeal of that provision would provide problems for a small but important number of applicants. Indeed, the department’s own evidence suggested that some applications, upon review, may have been inappropriate. It would be more useful for the government to accede to the amendment and incorporate that into the bill.

The bill should also 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 new ACFI to determine a minimum lower basic subsidy level.

In the move from the residential classification scale to the ACFI, the provision to downgrade the basic subsidy level 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 extended care in hospital. The residential aged-care sector is nervous that the determination could result in a significant loss of funds. Labor therefore propose an amendment that requires the minister to determine a reasonable level of reduced subsidy.

The Senate community affairs committee recommended that a review of the new aged-care funding instrument—that is, the ACFI—be undertaken 18 months after implementation to assess the implications for all aged-care service providers and ensure that the stated benefits are achieved. Such an amendment would provide for a formal review within 18 months of implementation.

The amendments proposed by the shadow minister would improve the quality of the bill, the policy of the government of the day and the way in which matters are implemented in residential care across the country. We do not see any reason why the government would refute those assertions or not accept the proposed amendments.

We say the bill is deficient; we would no doubt support it if the amendments were lost, but we are looking to find improvements in an area of public policy that has been ignored by this government for 11 years. The fact is that residential aged care has been neglected by this government for 11 years. It is an area that has not been well attended to by the government. Indeed, I think the government assumes that it receives a high degree of support amongst older Australians, and that assumption has led to its negligence of and contempt for older Australians in the main.

That is exemplified by the government’s approach to residential aged care—and, indeed, aged care in general. Before I was elected to the parliament, I was involved in the area of home and community care. It is certainly an area that needs continued real funding increases because of the demographics of this country. The member for Moreton was correct when he said we will have to rely increasingly upon immigration intakes to sustain a productive society. Our population is in decline and the ratio of producers to those who have already put their shoulder to the wheel for this country is reducing. There are fewer people in work now—as opposed to those not involved in either paid or unpaid productive work—than was the case only 20 years ago. So this has happened quite rapidly, Mr Deputy Speaker Quick, as you would concede. Indeed, that shift is now occurring more rapidly. So I accept the view that we will have to rely more upon immigration.

Indeed, this government, despite some of the dog-whistle comments it makes to the community, has a very high immigration intake. It is a trend which has been consistent since the time of recent Labor governments, which had relatively high immigration intakes. The immigration intake by this government has been very high—which is not always understood by the community—despite some of the pronouncements made by members opposite, including ministers.

As I said, it is clear that, because the government has assumed it has high levels of support from older Australians, it has neglected to attend to their concerns. This is one area in which there have been signs of neglect and failure. That is exemplified by the high level of change in the aged-care ministerial portfolio area.

I do not know how many ministers we have had in the last six years presiding over the portfolio of ageing, but it is a very high number. We do recall that one minister, still in this place but no longer a minister, presided over the kerosene bath scandal. Only last year there was an awful sexual abuse scandal, which I do not think was properly considered by the government, and the government has to take some responsibility in relation to that matter. Subsequent to that, we had a minister who had to resign because of a conflict of interest between his responsibilities as a minister and his share portfolio: he was investing in areas in which he was making ministerial decisions. Now we have a minister who, though he may say he has been misrepresented, certainly gave every indication that he is not particularly happy with his Ageing portfolio. He says it is because he is not old enough, or something like that—or he does not act old enough.

The matters I have just raised, the performance of Ageing ministers and the scandals in the sector, are indications of a government that really does treat older Australians with contempt or, at the very least, acts in a negligent manner in relation to the residential care sector and other areas that impact upon older Australians.

It is true to say, as the member for Moreton indicated, that it is not just about older Australians. It is also about people who are infirm and people who are disabled and require constant care but should not be taking up hospital beds. It is not good for them and indeed it is not economically sound. I think there has to be a better way. I do not think the government has really attended to that. I do believe that the Hogan report has sought to improve the way in which the aged-care residential sector operates—and I can go to some of the comments in that report which were picked up by the government and incorporated into this bill.

This bill is as much about the new funding model, which draws partly on the work undertaken by the resident classification scale review in 2002-03, as it is about projects arising from that review, such as the reduced RCS questions project. The new system will have fewer basic funding categories than the current scale and will include two new supplements. The new supplements are intended to better target available funding towards the highest care needs—in particular, residents with dementia and challenging behaviours, and residents who have complex health and care needs, including palliative care. The new supplements are to be implemented from within the basic subsidy funding which is currently allocated by the RCS.

Following the 2004 budget, the department commissioned Applied Aged Care Solutions to undertake a major study to identify and analyse structural options for the new funding model. The consultancy tested options for their impact upon the industry at service provider and state-territory level, and by rural and remote status. The study was completed at the end of 2004. In the following year, the ACFI was tested by those consultants in an Australia-wide national trial. All government funded aged-care facilities were invited to participate, and 678 homes participated in the data collection phase which concluded at the end of October 2005. The ACFI appraisals were conducted on aged-care residents and prospective residents by staff from aged-care assessment teams, nominated clinical staff from aged-care homes and Department of Health and Ageing RCS review officers. In New South Wales and Victoria, there was a small pilot of community and employment agency nurses also undertaking appraisals.

Those matters have been addressed in this bill. The amendments that we seek will, I think, improve the legislation if enacted.

The resident classification scale is effectively the basic tool used to fund residential aged care. How aged-care residents are classified is important because the amount of basic Commonwealth subsidy paid to residential care providers depends on the classification that residents are given. The scale goes from $22.27 per day, the lowest, to $122.77; so, clearly, it is a means-tested scale. The average subsidy paid to approved providers per utilised aged-care place in 2006 was $34,000. We do not have any problems with that scale. We certainly do not have any problems with seeking to reduce the number of classifications, subject to our proposed amendments being accepted by the government.

For as long as I can remember—probably since early in the first term of the Howard government but certainly for many years—Labor have been raising concerns that aged-care centres had about the amount of paperwork they had to undertake. There is a tension between, on the one hand, ensuring that aged-care operators provide sufficient information so we can monitor their performance and accountability in the sector and, on the other, congesting the administrative workload of operators so that they are focusing on paper rather than on the residents in their centres.

There have been some efforts to reduce the paperwork. We support any efforts to reduce unnecessary administrative work if it means staff can provide more care directly to residents in the homes. That would be far easier for the staff, who in the main do a magnificent job across the country in what I think is one of the hardest and least recognised jobs in this country. The fact is we are hoping to continue to attract people to look after our elderly, our infirm and, often, our disabled in residential care. If you were to look at these people’s employment conditions, compared to those of others with comparable skills but fewer responsibilities and higher pay, you would have to say that many of the staff do it because of a commitment to looking after people who desperately need care. We do not see that in every workplace. We certainly see that commitment by staff in the residential aged-care area, given that they know they can make more money in other areas while probably putting themselves through less stress and working fewer hours—but they do it.

Every time I visit a residential care home, I am amazed by the constant commitment to the residents. We know that the funding levels are not very high in terms of ensuring that the staff of such centres receive decent employment conditions. That has to be addressed in a fundamental way at some point. I am not suggesting it is an easy thing to address in any immediate sense, but there is a real need to review the way in which staff in aged-care centres are treated. We are going to lose too many good people if we do not ensure that they are properly remunerated. We must not rely upon their sense of responsibility for the care of residents. Instead, we must treat them like any other worker and pay them what they are worth—and currently they are not in receipt of that. I think child care is in a similar vein: people who have enormous responsibility and a significant array of skills are not properly remunerated for the work they undertake. That has to be addressed by both sides of politics in a bipartisan way very soon, otherwise we are going to have difficulty keeping the people that continue to work in centres and cope with the difficulties on a day-to-day basis.

I return to the issue of removing unnecessary administrative work. Of course we need to ensure that there is accountability, but staff in aged-care centres are asked to do some things that are not necessary. We have to weed out those unnecessary matters and ensure that the staff are able to focus on looking after the residents who need the care and daily attention of the hardworking staff.