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Wednesday, 20 June 2007
Page: 64


Mr MELHAM (1:08 PM) —I am pleased to take part in the debate today which focuses attention on a vital issue for our ageing population. The Aged Care Amendment (Residential Care) Bill 2007 proposes to amend the Aged Care Act 1997. Specifically, it proposes changes to the resident classification scale for those in residential aged care. This will be replaced with the Aged Care Funding Instrument. This is the actual means of allocating a subsidy to providers of residential aged care. Several other provisions were outlined by the Minister for Ageing in his second reading speech, in which he indicated:

The bill will introduce changes necessary to reduce the number of funding levels for basic care, as well as provide payments for residents with complex healthcare needs, including palliative care, and for residents who have mental or behavioural conditions, including dementia.

A funding model was established between the industry and the government, and a national trial was undertaken in 2005. All Australian government funded homes were invited to participate. Six hundred and seventy-eight homes chose to participate. Since then, some modification has been made to the model as a result of that trial. There is no doubt that this legislation, in a broad context, will prove positive for the industry.

Significant comment has been made about the amount of paperwork that staff, particularly nursing staff, are required to complete as part of the appraisal and reappraisal processes in aged-care facilities. The obvious benefit of this change is that it will release staff to complete the duties for which they were trained: caring for the elderly. In relation to that issue, the Australian Nursing Federation, in its submission to the Senate Standing Committee on Community Affairs inquiry into this bill, said:

The complexity of the RCS—

that is, the resident classification scale—

meant that registered nurses employed by aged care facilities spent more time documenting than providing care or supervising care provided by other less qualified staff.

The amendment bill provides fewer basic funding categories than the current system and will include two new supplements. These supplements are intended to better target funding towards the highest care areas, such as residents with dementia and complex care needs, including palliative care.

Currently the act requires that residential care classifications expire after 12 months and that providers submit reappraisals. Under the proposed changes incorporated in this bill, providers will have the option of reappraisal. Amendments will also allow a provider to accept a resident’s current classification when a resident moves from one facility to another rather than requiring them to submit a new appraisal. Finally, the bill will provide for the secretary of the department to stay a suspension of a provider where the provider has repeatedly failed to conduct appraisals or reappraisals in a proper manner. The suspension may be stayed if the provider meets specific obligations.

I commend the government on introducing this bill. The Labor Party has already indicated its intention to support it, subject to consideration of a number of recommendations in the Senate committee report tabled on 16 May this year. I have no need to remind the House of our ageing population—the Treasurer regularly does so. What the House must consider is how we as legislators are able to positively impact on this national issue. This legislation is one step in the right direction. Needless to say, it is only a first step. There is so much more to do.

In 1996 there were 92 residential care beds for every 1,000 people aged 70 years and over; today there are just 86. In 1996 there were 37,323 nurses working in residential aged care; in 2004 there were 33,794. This is despite the growing numbers of residents in aged-care facilities. Measure that against the fact that around 75 per cent of aged care is not provided by the government but by family and friends. I have spoken in previous debates of my concerns for those carers. With the changing demography of the Australian community, the number of carers will decrease, not increase. A report released on Friday, 15 June 2007 showed that the number of aged-care residents needing high-level care has jumped by almost 19 per cent. The report was released by the Australian Institute of Health and Welfare. The report revealed that 69 per cent of permanent residents required high levels of care in June 2006.

In the seat of Banks, there are 17 aged-care facilities. These range from traditional hostel style accommodation to the more up-market retirement villages. I am aware of the lack of high-level care facilities in my immediate area. Only recently, a gentleman came to my office seeking assistance for his wife, who is suffering from dementia. There were no appropriate facilities immediately available and the lady had to go onto a waiting list. During that period she was in hospital. The next available place was at Croydon, some 16 kilometres away. That is not the only example. Families have to accept places where they can get them. If a family member does not drive or public transport is not handy, there is considerable difficulty involved for family and friends to regularly visit. This, of course, adds to the guilt when the relative progresses to the stage where they need high-level care, particularly with illnesses such as dementia.

In the seat of Banks, I can say quite categorically that we need more high-level care places in our aged-care facilities. This is consistent with the information provided by Senator McLucas, the shadow minister for ageing, disabilities and carers. In her media release on 15 June 2007, she stated:

According to the Government’s own stocktake of aged care beds, in 11 years they have turned a surplus of 800 aged care beds in 1996 to a 2735 shortfall by December 2006.

In New South Wales alone there is a shortfall of 1,637 beds. Another area of concern is the lack of appropriately trained staff. As the population ages, this is only going to worsen. It is critical that we have adequate minimum staffing levels for aged-care facilities. We must ensure that wages and conditions are at a level such that we can recruit and retain nurses in an area that is struggling to keep them. This is in the interest of not only nurses and care workers but also providers—so they can attract and retain quality staff.

The Senate Community Affairs References Committee report Quality and equity in aged care, released in 2005, noted that delivery of quality care was under threat from the retreat of qualified nurses, both registered and enrolled nurses, from the aged-care sector. We must ensure that there are sufficient trained staff to service the needs of the ageing. Part of the reason for the lack of staff is the lack of attention given to skills training by this government. It is incumbent on this government to take appropriate steps to ensure that there is sufficient infrastructure for the training of aged-care nurses and other support staff. The service sector will continue to grow. We have a responsibility as a nation to equip ourselves for the future via some form of training for as many young Australians as we can, be it through a trade training opportunity or a university opportunity. A focus on training for people entering the aged-care sector is a win-win scenario.

This government must be serious about the provision of quality care for older Australians. The government must commit to seriously increasing the numbers of undergraduate nursing places and closing the wages gap between nurses working in aged care and those working in the public sector. The changes that this legislation proposes are significant in the impact they will have on how the industry operates. For that reason, it is important that the government considers taking steps to ensure that training in those changes occurs. The Australian Nursing Federation made the following recommendation in its submission to the Senate inquiry into this bill:

The ANF would like to see a commitment by the Australian Government and the Department of Health and Ageing to the provision of ongoing training in the ACFI. There is a high turnover of staff in residential aged care facilities and a high proportion of part time staff. The change from the RCS to the ACFI is a very big change, not just in assessment tools, but also in underpinning philosophy. It is anticipated by the ANF that a four year commitment to funded training in the ACFI will be essential for a smooth transition from one tool to another.

I note the minister tabled a policy paper with the second reading of this bill. The policy paper outlines associated changes to the Aged Care Principles 1997. It is important to the aged-care industry that detail is provided as soon as possible. These principles are critical to the function of aged-care providers. The impact these changes will have on the day-to-day operation of aged-care facilities is considerable. For that reason, and for certainty, the details are vitally important to providers. The classification principles will provide information about the level of funding that each classification level will attract. Providers need to be in a position to assess the impact of the changes on their operations. The explanatory memorandum makes it clear that there are no negative financial consequences in this bill for existing residents. On page 2 it is stated:

These costs will:

  • ensure that the level of funding for an existing resident will not decrease when they are reassessed under the new Aged Care Funding Instrument;
  • provide additional funding for the top levels of the two new supplements; and
  • establish a panel of advisers to assist homes manage the transition to the ACFI.

I congratulate the government on its approach to the process involved in establishing this bill. The level of trial and of consultation does appear appropriate. I commend the bill to the House.