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Wednesday, 13 May 1987
Page: 3123

Mr COWAN(6.08) —We are addressing the Nursing Homes and Hostels Legislation Amendment Bill. We should recognise it as a further step in the care of aged people in Australia. As Australians we have a wonderful record so far as care for the aged is concerned. The honourable member for Lowe (Mr Maher) cited the number of people we accommodate at present in nursing homes compared with other countries. We must pay tribute to our own communities. Those of us, especially those living in the country, who have memories will certainly appreciate the initiatives of various church and other community groups which, over the years have instigated projects for the care of the aged in their communities. They approached the Governments of the day, both Commonwealth and State, and, after raising a certain amount of capital for care and administration, were responsible for establishing many centres throughout Australia. I did not hear the honourable member for Barker (Mr Porter) say anything about passing over responsibilities to the State. I thought that he was most fair and addressed the question of the care of the aged in a practical way. The National Party of Australia intends to do the same.

The legislation before the House is long awaited. In 1983, when the Government came to power, it virtually froze the funding of nursing home establishments throughout Australia. It was not a complete freeze, as some beds and hostel accommodation were approved later. There have been two inquiries, the McLeay and the Giles, and we now see the legislation before us. However, we have waited a long time for some move to be made. I trust that those who administer the homes and hostels, who are experts in their field, have had the opportunity to advise the Minister for Social Security (Mr Howe) and the Government on the necessary steps to care adequately for the aged. I do not wish to go into the statistics, but there are now well over 60,000 aged Australians accommodated in nursing homes, and it takes about 60,000 people to look after them. Therefore, it is an industry although we do not want to look at it from that point of view.

It is predicted that, by the year 2000, an extra 44 per cent of Australians will be over the age of 65 years. While it may now be costing us $1,000m to care for them, we must appreciate that that figure will grow as the years go by. That is why it is so important that this legislation will be exacting, or close to exacting in the long term, in order to develop this particular aged care.

The emphasis in the legislation partially turns away from nursing homes and towards hostels. We of the National Party do not oppose that, but we want to warn the Minister that there is a possibility-and it is certainly the case now-when all of us will tell him that there is a demand for extra nursing home beds in our electorates. The position must be the same throughout Australia. The legislation deals only with 80 per cent of the nursing homes, those owned by community groups or privately owned. The 20 per cent owned by the Governments of the States will not be touched as closely.

I understand that it is thought that the standard of nursing home care is not what it should be. I am not aware of that being the case, but we must admit that, perhaps, when we go to the cities or elsewhere adequate accommodation is not available. I hope that the legislation will, in a sensible way, tackle that problem over a period of time. I know that the country people whom the National Party represent believe that the nursing homes, hostels and units associated with them are of a very good quality. That should be known generally, as all of them have very long waiting lists. Therefore, we talk about the future and the way to tackle the problem.

We will not move amendments in the chamber, but I do not know what the Senate will do. After we have had time further to examine the legislation-time has been short as the Bill only came in last week and, as the honourable member for Barker has said, it is complicated-if we think that there are any anomalies, we shall move amendments if necessary. What we want to do is to point out to the Government the various necessities, the over regulation and the problems that arise with too much government control.

As I said earlier, the emphasis in the legislation is towards hostels. There is a nursing home program which, over three to five years, will limit aged accommodation to 40 out of every 1,000 people over the age of 70 within a region. The new funding arrangements are very difficult to understand. I know that they are outlined in the legislation, but one has to be more or less an expert to work them out. I am sure the Minister would agree with that. There is a mechanism for the standard of homes, building of homes and the care of the people concerned. There is also the approval of patients who will receive the care and the benefits. There is a provision for 42 days for revision of fees. I am pleased about that because the fees should be kept as up to date as possible. There is also a provision to prevent proprietors from charging admission fees.

Let us look at some of the operations in the care of the aged. We agree with the Government that there is a need, wherever it is possible, to keep aged people within their families. If the family is in a position to care for them-to give them the home and medical care that they require with outside assistance-we should certainly keep them in the home. We know that HACCS, meals on wheels and other groups are fulfilling a tremendous purpose in that area. Such services will have to be expanded. However, once we begin to expand some community groups within the home suburbs or towns, we must realise how far we can take that. Once a voluntary community group is set up, whether within the social security or other areas, it does a job within the community and eventually applies for funding from the Government. Almost always, the Government turns around and says `Right, we will supply the capital for a co-ordination officer', or something like that. Therefore, the money that comes from the taxpayers' purse goes on the payment of a person who is virtually non-productive.

I want to emphasise that if there is to be care for the aged in the home, it must be done constructively with the involvement of the medical fraternity, district nurses, hospitals and, certainly, the voluntary organisations and individuals within the community. I believe that they hold the secret to the care of the aged, or any group, within the community. Australians are pretty voluntary minded in helping those who need assistance in the community. The various care services of HACCS in the home cost more than $17 per hour, but there is only a $2 assistance towards that.

I spoke earlier about the units. I do not mind hostel care, but if the emphasis is to go that way I am concerned about the importance of that being flexible in order to cope with the demands. If we cut back the nursing home bed accommodation, we must allow the flexibility to admit a person who is old or frail and who needs care. There must be that flexibility within the hostel. The legislation provides that there must be qualified nurses in charge, and all the other paraphernalia. That is all right, so generally we support the hostel aspect of the Bill, which we think could be very effective.

However, the person who will be admitted to a nursing home bed is someone who needs virtually 24 hours a day care. These people are frail. They are ill. There is a possibility that, after care, they will be discharged. However, they will require care. Let us consider how these people are admitted. At present these people are admitted to nursing homes upon the advice of a government medical officer, their doctor, the matron and maybe the board of the nursing home concerned. This system has worked very effectively over the years. But we are going to change the system. We are going to set up assessment committees which may be based in a town or in a region. I do not know who is to sit upon the assessment committees, but I hope that the patient's medical adviser, his personal doctor, will be consulted about the situation of the patient concerned.

I would like the Minister to explain who will be on these assessment committees. There will have to be separate committees to deal with each nursing home or group of nursing homes in a regional area. These assessment committees must have a lot to do because, whereas the cost of the present admission system is $4m, the new system will cost $16m. That is a lot of money. What concerns me is that a bureaucracy will be set up. Many people will be paid allowances by the Government to perform these duties when perhaps they would be better carried out voluntarily by experts who really know the problems of the patients concerned.

The manual entitled `Living in a Nursing Home' refers to many matters we would like to know more about. The relatives and friends of the patients concerned will have certain freedom to advise the administrators of nursing homes as to the care that is required for these people. Often a nursing home is like a primary school and it must have a certain amount of discipline. We are talking about old people. We may all reach the stage when we are not able.

Mr McVeigh —Even the Labor Party will agree with you there.

Mr COWAN —I will not offend the Government side. There are plenty of fellows on that side who are not bad chaps. We will all be old one day. As we study the manual we get a few shocks. We find out that inmates of nursing homes are entitled to things such as the nomination of their meal times and the frequency of their showering and bathing times. They can even select the colours of the walls and the carpets in their rooms.

Mr Humphreys —So they should.

Mr COWAN —Yes, but there is a big turnover. Nursing homes do not want to have to change their carpets once every six months or every month. That might be impractical. But under this legislation these things could happen. Therefore, the legislation has to be analysed very closely to see what it really means. I want to spell a few things out because I think they are very important. We do not want to see people hamstrung. We do not want patients to be worried about a relative or friend continually demanding things that might not be satisfactory for the patients concerned. I have great faith in the present administration of our nursing homes and hostels. Who is better able to say which patients they will admit or what care they will give within a nursing home than the matron and the executive of the nursing home itself, and the local doctor of the patient concerned?

Mr McVeigh —That seems sensible to me.

Mr COWAN —As the honourable member says, it is sensible that they should be the ones who assess prospective patients and decide on the care that is required. We are not against therapeutic care. We want patients to have the maximum of care. These people are good people who have fulfilled their duty to society over a long period. None of us would challenge the responsibility of the Parliament, or anybody in this country, to care for the aged. I emphasise that we must never overlook local community groups and voluntary organisations in the area of aged care. If we do so the cost to the taxpayer will be enormous. There are the churches. There are the Frank Whiddon masonic homes. Many groups are active in my electorate of Lyne. They are setting up institutions to care for the aged. We have to be aware of these things.

Forty seven per cent of aged care accommodation in Australia is provided by private institutions, by people who have had the confidence and encouragement to build a nursing home to service those in need. The future demand for this care will be met by these people-people with initiative who are prepared to expend their money and invest. I am worried about some provisions of the legislation. I hope that no government will discourage community groups and private people from establishing nursing homes. A nursing home may not seek assistance from the Government either in the form of deficit funding or of a capital grant. It need not seek actual approval. Certain approvals are required, however, by both the Commonwealth and the States.

The National Party is very interested in the legislation because we represent electorates throughout Australia in which many people from metropolitan areas retire, particularly along the eastern coast. This is where the demand is for aged care. We make it clear that we want to give full encouragement to anything which keeps the family together. Not only in legislation but in all issues concerned with Parliament, whether social security or health, we encourage the family to keep together as a unit, to look after its parents, its uncles and aunts. Where necessary in every way we shall encourage the provision of quality aged care, as in the legislation before the House this evening. We recognise the valuable contribution of churches and community groups in providing health care for the aged. I mention St Vincent de Paul and other community groups. Therefore, we are absolutely opposed to over-regulation and bigger bureaucracy. We believe in efficiency.

Mr DEPUTY SPEAKER (Mr Ruddock) —Order! The honourable member's time has expired.