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Wednesday, 13 October 1971
Page: 2283

Mr JACOBI (Hawker) -I want to deal with clauses 1 to 3 which relate specifically to nursing homes. Let me say at the outset that in my view the increased subsidy provided in the Bill is quite insufficient. As I understand the position, the appropriation for ordinary benefits for 1970-71 was some $29.75m. In my view the subsidy payments ought to have been doubled. According to the Minister for National Development (Mr Swartz) the expenditure for the remainder of this year will be $24m. It is anticipated that this will rise to $51m in 1971-72. 1 ask: Is it too much to ask the Government to double the subsidy? My figures show that the cost of doubling the ordinary benefits would be $59m and to double the intensive care subsidy would cost $39m, a total of $98m. I am not talking about private nursing homes but about the non-profit sector and the public sector. I venture to say that the subsidy at this time is nothing more than a holding operation. It will certainly not take care of any future or immediate increases in costs, nor will it provide for an extension of services for straight out nursing or supervision. In the case of private nursing homes there will no doubt be exceptions to the rule, and in my view the majority of this increased subsidy will not help the pensioner but will add to the profit of the private nursing homes. Funds ought to be provided so that we can permit further action which will inevitably be required such as the daily provision of facilities for retraining and rehabilitation, the provision of day centres and day hospitals for senior citizens, a much more comprehensive coverage of the community with domiciliary services and an increased number of nursing home beds available to people, particularly those with limited incomes.

In the limited time that I have I want to refer to the intensive care subsidy On 3 occasions I have raised the matter direct with the Prime Minister (Mr McMahon) and with the respective Ministers for Health requesting that a line of demarca- tion between the ordinary care subsidy and the intensive care subsidy still remain. It can only be assumed that those responsible for its retention are unfamiliar with modern geriatric nursing practice, and it is important that the whole policy regarding the day bed subsidy be reframed to guard against the easy abuse of the present system. The same point is made by the President of the South Australian Branch of the Australian Medical Association. In the Adelaide 'Advertiser' of 7th October he is reported as follows:

The AMA suspects that some homes kept patients in bed and purposefully did not rehabilitate them so that they would attract the intensive care benefit.

The article continues:

Doctor Hecker said the AMA favoured the abolition of the ordinary nursing home rate and the payment of a single benefit with perhaps a slightly increased benefit for pensioner patients. ( disagree with the latter but I certainly agree with the former.

The other point that 1 want to make briefly is that the intensive care subsidy is discriminatory in concept and in application. 1 can speak with some authority of the position of 2 non-profit homes in my own State. In both cases they provide physiotherapists and occupational therapists-, the net result being that because patients are ambulatory and not bedridden, which is the normal basis for assessment insofar as the Department of Health is concerned, the ratio between intensive care patients and ordinary bed patients drops to about 33 per cent. It is much higher in private nursing homes. The net result is that the proportionate subsidy attracted by both the institution and the patient is chiselled off. This is quite wrong, lt ought to be the reverse, if anything. I have known of a ridiculous situation where a constituent in a hospital in another electorate had been paid an intensive care subsidy for the preceding 12 months - she required it to reduce the cost - but on the day following' her transfer to another hospital in my electorate the intensive care subsidy was cancelled by the same doctor who had approved it. If there is any logic in that I fail to understand it.

As I see it, presumably the concept and application of the intensive care subsidy is based on the notion that the greater the incapacity and decree of incontinence of an old person and the more bedridden he is, the greater are the demands on an institution. Anyone with any understanding of geriatric care will realise that this is not necessarily the pattern of what happens in geriatric hospitals. As I have pointed out, those who are confined to bed and who are grossly incapacitated may well be less demanding and require less care. More often than not, they are put to one side and completely forgotten. The patient who can sit out of bed and who is partly ambulant, may require far more attention. He or she should be encouraged by the nursing staff to undergo a period of rehabilitation necessitating physiotherapy and occupational care. I think that the criteria should be not whether a person is bedridden - this seems to be the common norm on judging whether intensive care should be applied to a. patient - but on the amount of intensive nursing care required by the patient, whether or not he is ambulatory or bedridden. The whole question of the intensive care subsidy should be thoroughly exa: mined by the Government. A new set of guidelines should be established and the subsidy should be granted with far more compassion and human understanding than is the case at present.

Mr Donald Cameron (GRIFFITH, QUEENSLAND) - You name the guidelines.

Mr JACOBI - The honourable member is a supporter of the Government and it should establish the guidelines. As I understand the Minister's second reading speech, the Government intends this to be an interim measure. I should like an assurance from the Minister that this is so. Can he indicate when honourable members may expect to be tabled in this chamber a report of the Government's comprehensive policy to alleviate the suffering of the aged, the frail aged and the sick aged? When can honourable members expect an increase in the subsidy, because such an increase will achieve ari improvement in the care of the aged and the sick in the non-private and State government areas. I point out to the honourable member for Griffith (Mr Donald Cameron) that the Commonwealth Government's grant for the . care of the aged in South Australia will be $465,000 over a 5-year period. The State Government has committed itself to alleviating the burden of hardships on the sick and the frail in South Australia and is confronted with an expenditure of $14m. In my view, the Commonwealth Government's grant is totally inadequate.

The DEPUTY CHAIRMAN (Mr Hallett) - Order! The honourable member's time has expired.

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