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Tuesday, 16 October 1984
Page: 1789

Senator GILES(9.21) —This evening we are debating amendments to the Health Legislation Amendment Bill 1984 and the Social Security and Repatriation Legislation Amendment Bill (No. 2) 1984. I would like to concentrate my remarks on two aspects of the amendments to the health legislation. Those aspects are: The introduction of changes to what has become known as the 35-day rule and the introduction also of a scheme whereby respite beds will be made available in nursing homes. It was extremely interesting to hear Senator Messner refer to his Party's philosophy of encouraging people to care for themselves in their old age. But as far as I could hear the only positive measure that he was advocating was an increase in the number of nursing home beds, having criticised the Government trenchantly for holding down the increase in the number of beds over the past 18 months.

It is very clear to those of us who have looked closely at the industry and at the need for nursing home beds and other care for the aged that simply increasing beds is certainly not the way to deal with the needs of the aged. For example, Senator Messner's references to Meals on Wheels, and his emphasis on the fact that many people volunteering their time and energies to providing Meals on Wheels are people of, shall we say, mature years, points up the fact that the vast majority of aged people are quite fit-in very many cases very fit- and that only 7 per cent of those over 70 in Australia currently are in institutionalised care. It is also evident that the type of care that many of those people in institutionalised care are receiving is not appropriate to their needs. In many cases nursing home attention is not what they need but some other sort of supported accommodation. I felt that his remark about the age of women involved in Meals on Wheels was rather gratuitous. His method of coming to those conclusions rather intrigued me. As somebody who has had a very close association with Meals on Wheels, being one of the volunteers for some years, I assure him that a fairly high proportion of those who contribute their time and their efforts are of less than mature years.

The legislation before us tonight includes amendments to what has become known as the 35-day rule. This has replaced the old 60-day rule which required that patients staying in private hospitals for a period longer than the specified period should be certified as being in need of acute care to continue to be eligible for health insurance past that time. It was evident towards the end of the 1970s and the early 1980s that that rule was being breached quite flagrantly in many cases. Some publicity was given to the fact that patients were being recruited, signed up into private insurance companies and, as soon as they became eligible, admitted, not to nursing homes, but to private hospitals, where they stayed in some cases for months and even years. These patients were 'ping- ponged'-I believe that was the expression-between a range of hospitals. They were sent for a few days here, a few weeks there and a month or so somewhere else. In many cases the diagnosis was the sort of thing that one would expect of a reasonably fit elderly person-a little back pain, poor eyesight, diabetes, a bit of congestive cardiac failure, maybe a nervous disorder. Insurance companies and the Government were paying out vast amounts of money to keep these individuals, comfortably I hope, in private hospitals where they had no need to be.

We have already changed that rule to say that after 35 days an individual who needs to stay in that environment must be certified as in need of acute care. These amendments modify that requirement to the point where the individual who may need to be moved perhaps from acute care into a chronic care nursing home or some other accommodation is protected much better than was the case originally. There has been a great deal of exaggeration about the difficulties that this has created. But it certainly is a fact that in some States nursing home accommodation is at a premium and there may in fact be difficulty in finding alternative accommodation for the individual who cannot be certified genuinely as in need of continued acute care and therefore continue to be eligible for medical insurance.

The procedures, of course, have been improved and expedited. I emphasise that throughout this exercise the welfare of the patient is paramount and that the doctor must take responsibility for this certification in a way that perhaps has not been so evident in some cases in the past. In the period to which I referred earlier certificates were not signed by doctors and clerical staff and nurses were expected to take this responsibility. The matter certainly was completely out of hand for a while. The procedures have been improved and expedited specifically to reduce hardship in case of review to the acute care advisory committee in each State.

The other issue I wish to address is the one that now allows for nursing home benefits to be paid to individuals who wish, for some reason or other, to be temporarily absent from a nursing home. This will be of great advantage to two quite clear groups of people. First of all it will benefit the person who wishes to leave the nursing home for a night or two or perhaps a week or two and who until now had to reimburse the nursing home for the Federal benefit which would not be paid for the period of absence. The other group that will be at a great advantage is those patients and their carers who may take advantage of those otherwise empty beds in nursing homes for a few days or weeks in the course of a 12-month period. The reasons for which people may wish to be temporarily absent from nursing homes are many and varied. Probably the most common ones would be hospitalisation for a short period or perhaps to take a vacation for a special family occasion. We have heard of one individual who was absent from a nursing home in order to take a world trip. However, in that instance questions might have been asked whether nursing home accommodation was appropriate for that individual.

Previously, and certainly this still is the case- nursing homes had an incentive to maintain a very high bed occupancy rate. This is because high bed occupancy in the case of private enterprise nursing homes obviously is highly desirable in terms of viability. These amendments allow for an agreement to be reached between the nursing home proprietor and the patient or the representative of the patient and set out the obligations of both parties in the event of the patient leaving the nursing home temporarily for one reason or another such as those I have explained. Instead of as previously the patient being required to pay both the patient contribution and the benefit, which can vary from $23.40 a day in Western Australia to $45.15 a day in Victoria, the amendments allow that the patient may be elsewhere for a total of 28 days in a year and the Commonwealth will continue to pay the benefit for that time.

In addition to this totally reasonable and humane initiative, beds thus vacated may now be made available for the provision of respite care, a term which refers to short periods, days or perhaps weeks, during which disabled or frail aged people usually cared for at home may be admitted to a nursing home for any one or a range of reasons. The most common of these reasons is to give the carers a rest from what is often a labour of love but is demanding of time and energy and can be emotionally taxing as well. Other reasons for temporary admission, or remission for the carer, may be the short term medical needs of the patient, the medical needs of the carer certainly, or short term intensive periods of nursing where an individual's condition has changed over a period. The availability of such respite beds has been very low until now with only deficit funded nursing homes being in a position to reserve beds for such use, and only a few of them having actually done so. This new arrangement will add to the comfort and peace of mind of very many patients, not just those in deficit funded institutions but also those in private enterprise nursing homes and will also add to the well- being of the carers and, I venture to say, the proprietors of nursing homes who in many cases will be very glad to be able to provide this extra community assistance and service. It is a highly commendable development. The only costs for the temporary patient will be the usual patient contribution of 87.5 per cent of pension, plus, in private enterprise nursing homes, any difference between the benefit paid by the Government and the full fee.

The same arrangements will apply to patients and those seeking respite in deficit funded homes and those who are the responsibility of the Department of Veterans' Affairs. From my observations, the Department of Veterans' Affairs is probably in an excellent position to implement this very quickly and very efficiently, in view of the excellent assessment procedures that it already has operating. There is a guarantee that there will be thorough discussions between the Government and the nursing home industry and those who speak on behalf of patients prior to the introduction of this scheme. In order to optimise the advantages it would seem reasonable to me to administer the scheme on a regional basis from a central registry which could quickly identify beds which are vacant or about to become vacant and match them to those in need of respite care. Australia is relatively well supplied with nursing home beds per capita of our aged population, but their distribution is uneven and their utilisation is far from effective. This new program is a very welcome step.