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Tuesday, 20 September 1994
Page: 991


Senator LEES (Deputy Leader of the Australian Democrats) (4.12 p.m.) —I would like to begin by disagreeing with Senator Crowley, although I acknowledge that the government has made improvements particularly in the quality of care for aged Australians. But we are looking today more specifically at the needs of people suffering with dementia and the volume and range of services in that area. However, as I read this proposition before us today I see that it gives me some flexibility. I will talk more generally about aged care services before specifically addressing the needs of those elderly Australians who have dementia.

  As I have travelled around South Australia I have come to look at in particular the range of aged care services and the use of inappropriate services because of the lack of general options, particularly home care options. I have not gained this information just by talking to those in hostels and nursing homes but also by talking to aged care assessment teams, to those responsible for HACC programs and in particular to those people responsible for running our public hospitals—those who are perhaps on the boards or are CEOs.

  Here we see—and I have to emphasise that I am talking generally about South Australia and I am not looking interstate—that in most rural areas local communities are struggling to provide just basic services for people requiring aged care. Part of this goes back to the government's philosophy that we need a very large number of people in order to have a nursing home. Indeed, we are looking generally at 30 beds before permission is given to build a new nursing home service. That means that many people in rural Australia either have to move—and that means being cut off from family and friends—or have to put up with inappropriate placement in the local hospital.

  If we look at the cost of continuing to place older Australians in hospital care, we see that it is by far the most expensive option. It is more expensive than nursing homes, which is in turn more expensive than hostels, which in turn are far more expensive than being able to maintain people in their own homes.

  This problem is not just in rural South Australia—and here I particularly concentrate on the western suburbs of Adelaide where I live, where over 100 places are still needed for those who want hostel care, where it takes weeks to get an elderly relative on the list just to be showered at home, and where even Meals on Wheels is not an automatic certainty as, again, people have to put their names on the list to be certain that they will be able to access that service as required. Any sort of respite care there is almost unobtainable—and I am not particularly looking at care for those with dementia. While I acknowledge the government's improvement in the quality of care, and particularly what it has done for the rights and responsibilities of people in nursing homes and hostels, we certainly have a major problem with the actual availability of care.

  If we look specifically at the community care problems and the options—and I acknowledge that the aged care packages are a very welcome innovation—we see that the government is simply wasting money by pushing people into the most expensive option of ending up in hospital beds. It is also pushing relatives and friends to the brink where indeed we might have not one but two older Australians in need of care because the respite facilities are simply not there. People in the nursing homes that I have spoken to about their respite services tell me that they need months and months of planning to know that people will be going into hospital or perhaps will be sick so that their elderly relatives can have some respite care. Indeed, there have been incidents where both the patient and the elderly person have turned up at hospital with bags packed as that is the only option for people needing to go into hospital for an operation.

  I want to look quickly at the fact that the number of frail elderly people is increasing, and the minister acknowledges this. We have the statistics already. We know what we should be planning for, but that planning is very slow. There is a high rate of admission to hospital for these elderly people. They represent a high proportion of the users of hospital services and therefore are very high users of our health resources.

  Health services for these people will become increasingly important over the next five years. The Commonwealth and states in particular need to sort out who is doing what because the duplication, the crossing over of services and the lack of services for some people while others can tap into two or three different services are major problems—and, again, I concentrate on my home state. There is far too much confusion, duplication, administrative inefficiency and cost shifting between the states and the Commonwealth. I look at what the government in my state is doing. It says that it will reduce the cost of running its hospitals, when most of that reduced cost is simply being passed straight on to the Commonwealth.

  I particularly acknowledge what the previous minister for aged, family and health services, Mr Staples, did in the area of quality programs. But it is one-sided to set a very high quality for some older Australians and to leave others, particularly those with dementia, without any support and particularly without support for their relatives and friends.   There are two initiatives that the Democrats are proposing. Firstly, there is the extension of the personal care tax rebate. That is expanding the eligibility criteria for the medical expenses rebate to people providing personal care at home for a friend or relative with moderate to severe dementia. At present these carers are not eligible for the rebate, despite incurring significant medical and care costs. I stress again that this is the cheapest option for government. These people are saving the Commonwealth huge amounts of money by caring for relatives at home. Let us give them some additional incentives and, in particular, some real support. We also need to see an increase in the home and community care program and again a sorting out with the states to make sure that the states are matching the money that is being put in. I do not know how we will do that.

  We also need to look at increasing home nursing services, and not just in this area. This is particularly important as states move to case mix funding because one of the most vulnerable groups in the community as we move to case mix is elderly Australians who may not have that level of support they need at home. They may need nursing care for far longer than the hospital is able to provide. Indeed, some suggestions are that they will need that nursing care for four times the length of time that a traditional, fit, middle-aged Australian will need that level of care.

  I will shorten my remarks to enable Senator Chamarette to speak for a brief three minutes. My final comment is that we acknowledge this government's improvement in the quality of services, but the amount of money put into this area is barely keeping up with the existing level of need. It is not coping. It is not realistically planning for the future that we know is ahead of us when more and more Australians will fall into the group needing a range of services as the population ages.