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Wednesday, 9 October 1991
Page: 1627

Mr BRAITHWAITE(11.35 p.m.) —-In speaking to these estimates, because of the time constraints and as I will be addressing some matters on disability services tomorrow in a notice of motion, I thought I would centre my remarks around the age care section, residential and HACC programs.

When talking in terms of aged care, of course, one is talking basically of residential and home care. I will address some comments to various aspects of it. The functions within the Budget made changes in respect of hostels, particularly in the restructuring of hostel subsidies, whereby under the new restructured personal care subsidy arrangements that will be implemented as from April next year, three levels of personal care funding are provided for. Those arrangements will provide for increased funding for very frail residents and those suffering from dementia. By that time we will be having a GAT assessment not only for nursing homes but also for hostels.

The three levels that attract subsidies are the top level of basically 10 per cent of residents, which will be at $28.85 per day; the intermediate level, which will attract a subsidy of $26.20; and the lower level, which will attract a subsidy of $23.55. I express concern for those hostels around Australia that have been receiving dementia grants and have tailored their arrangements to the care of dementia patients. This program means that the subsidy they were enjoying previously under that grant of $30 will be diminished to the top level of $28.85, so there will be a diminution of care.

The Minister for Aged, Family and Health Services (Mr Staples) is in the chamber, and he probably knows what I am talking about when I refer to some of those special dementia units which have been operating over the last few years. They have been operating at a loss even in spite of that subsidy, and they have been drawing on their State governments for subsidies.

The one I am referring to basically is the Lefroy special hostel for ambulant dementia sufferers. I was at the residence about six weeks ago and I was shown figures that that hostel had been keeping for the last three years, indicating that if some of these dementia patients had gone into a nursing care situation or into any other care, they would have incurred Commonwealth expenditure to a far greater extent than under the hostel's own program. As I said, even at $30 a day the hostel was getting a grant from the Western Australian Government. I think it was a three-year grant. As I understand it, that grant finishes this year and in view of the pull back or the drawback of the subsidy, establishments such as Lefroy do have a funding problem.

I know the Minister is aware of the hostel; I know he is aware of the program. I would just ask him what the situation will be in the event of these figures showing a massive loss. I think it is about a 40-bed hostel, and such a loss would mean it would be financially embarrassed. The establishment itself is part of a wider Anglican care of the aged in Western Australia. I know that it will be looked at very carefully.

There has been a reduction in the percentage of the population over age 70 who will not be accommodated in hostels. It has been reduced from the figure of 60 in every 1,000 to 50. Funds are intended to be put into the home and community care program. We will be looking, with a certain amount of interest, to see whether that happens. The HACC programs are at the moment basically underfunded, from what I hear from the States. I am not sure that is the correct way to assess such a situation, but that is the situation there.

Mr Staples —-It was reduced to 55.

Mr BRAITHWAITE —-Reduced to 55; sorry. So we will be looking very carefully at that. I will now deal with the nursing home aspect and the CAM funding system. It has been reviewed to the extent that there is to be a discount on the CAM standard hourly rate of one per cent. That will put pressure on nursing staff already stressed under the current arrangements. The withdrawal of that one per cent could have some effect on the funding arrangements and also, unfortunately, on the quality of care along the way.

I will now deal with the resident classification instrument, which has been reviewed and, as I understand it, is undergoing further trials before it is phased in from April 1992. A lot of concern has been expressed to me about the amount of nursing time which goes into this assessment. I can understand that, for accountability reasons, it is necessary for a person to be assessed properly, but I get the feeling, from speaking to directors of nursing right around Australia, that the amount of time involved in the resident classification instrument means that precious hours are being taken up which could be better utilised to enhance the quality of care. As I have said, I can understand the need for accountability but, in some ways, the nursing staff do regard this as a further harassment from the point of view that some of these requirements are just a little over-exaggerated as far as staff needs are concerned. I do hope that when that review comes out some concern will be shown for those people.

There have also been changes to infrastructure funding. When indexing SAM for 1992-93 and thereafter, it will be varied for changes in the average Australia-wide occupancy over the last 12-monthly period for which figures are available and also for changes in average dependency. For many years, charitable and benevolent organisations have received capital grants to assist them to build new nursing homes or rebuild existing homes. Proprietors who did not receive capital grants will now receive supplementary recurrent funding for 10 years for new homes.

Remote homes, whose infrastructure costs are substantially higher because of their location, will receive additional funding of approximately $3 per resident per day as from 1 May 1992. The Opposition wholeheartedly endorses that extra funding for those people in remote areas because they suffer additional costs which are not really understood by those people living in capital city areas.

The problem we have with the alterations to the SAM is that, although there is a review still going on, some changes have been made. As far as the people in the nursing home industry are concerned, the SAM component is woefully short of what is required of it. Again, I believe it is up to the industry people who feel that the SAM funding is short of what it should be--bearing in mind all of the considerations--to keep the pressure on the Government to ensure that the SAM review is completed properly. There are also revised CAM acquittals. As I understand it, this means that these will be made every quarter instead of every 12 months in order to ensure that those excess funds are repaid on that basis.

I want to mention another aspect of the HACC program and also the need to have proper distribution of those funds. In Queensland, we recently regionalised 13 areas through the Health Department. These are autonomous areas which are not only distributing funds for hospitals, but also distributing some funds which are provided by the Commonwealth--namely, GAT and the HACC. I have been looking very carefully at these health regions because, depending on the manner in which the regional administrators go about their duties, I would like to make sure that the funds can be applied properly, because it is an avenue under devolution. I would like to make sure that some of those funds which the Commonwealth distributes also go to those regions. I hasten to add, in connection with the HACC program, that I hope that these funds will be applied as they have been in the past. (Time expired)