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Wednesday, 2 December 1998
Page: 1046


Senator GIBBS (11:15 AM) —I rise to speak on the Aged Care Amendment (Accreditation Agency) Bill 1998 which, to my mind, is just another aspect of this government's relentless attack on the elderly. On the surface, the bill seems reasonable enough. No-one would argue that there should not be an agency defending and ensuring a high standard of care within aged care facilities. However, it is the uncertainty surrounding the exact monetary implications of this measure that should be of particular concern. The Aged Care Standards and Accreditation Agency is currently funded by grants made under the Aged Care Act. The bill before us seeks to enable the agency to charge fees for its accreditations, allowing it to recover costs. The problem is that the government has refused to give any solid indication of what these fees might be.

The fees must not be such as to amount to taxation but, beyond that rather vague assertion, we are completely in the dark as to what an accreditation might cost. Understandably enough, it has been fairly difficult for service providers to assess the impact the accreditation fee might have when they have no idea how much that fee might be. It has therefore been virtually impossible for anyone to gauge the impact of this bill.

If the fee is low the impact will be minimal. However, if the fee is implemented at a higher level, some small service providers could be forced out of business. The bill allows the agency to set fees at any level without parliamentary control. The government's failure to reveal the fee or even a possible range of prices has created an atmosphere of considerable uncertainty and apprehension among service providers. Hence, this bill has become just another example of this government's smoke and mirrors approach to reforming the aged care sector. They continue to speak in notional rather than specific terms and their policies fail to outline funding arrangements that will ultimately determine the survival or failure of small service providers in particular. It is the smaller service providers who will be hit hardest by this new measure, no matter what the fee ends up being.

At the moment, 50 per cent of nursing homes have fewer than 41 beds and many of these smaller facilities are in rural and remote areas. Submissions to the current productivity inquiry into nursing home subsidies have indicated that nursing homes need at least 60 beds to operate efficiently under the government's regime. Given this fact, it does not take a rocket scientist to work out that there are quite a few service providers struggling to survive in this environment. How are these facilities expected to endure further decreases in Commonwealth funding? They will, under this measure, have another substantial cost to consider. The only trouble is they cannot even consider it at the moment because the government is refusing to tell them how much the fee will be.

I imagine that at the moment this bill represents a considerable nightmare for small service providers. They have not been able to lobby against it because, without knowing the cost, they cannot say how many facilities will be affected. At the same time, they are unable to reassure residents that everything will be all right because, quite frankly, they do not know. They do not know whether they will be there after this bill goes through. It is impossible to tell. Even if this government does not care about the service providers, what about the residents? How do you think those people feel, knowing that they may not have a home after this measure is implemented? They probably will have a home, they might have a home but, then again, they might not.

If 50 per cent of nursing homes have fewer than 41 beds, and 60 is the commercially viable number, then this measure will undoubtedly hit small providers very hard. Many of these facilities are in rural and remote areas and their closure would have a terrible impact on rural communities which are already losing government services right, left and centre. Older people in country centres have a lot to lose if their small service providers go under. Not only will they be faced with the difficult decision to leave the family home when they need more care but in many instances this may necessitate leaving town as well. Older people often put off leaving the family home, even when maintaining it becomes too much, because they do not want to leave behind the security and independence it represents.

Imagine what a daunting prospect such a move would become if they also had to consider leaving their immediate family and friends. The government simply has not considered some of the practical implications for country people of its bill. Many older couples are separated by illness for long periods of time. Often, if one becomes frail or needs to recover from some sort of treatment, they will enter a nursing home while their spouse stays in the family home. Obviously, it is very important that these people remain in close contact in order to make the whole experience less stressful. Imagine trying to recover from a major operation with your husband or wife hundreds of kilometres away. Worse still, imagine trying to care for and maintain contact over such a distance with a spouse suffering from Alzheimer's.

Taking facilities from country areas will only exacerbate older people's phobia of nursing homes. No-one wants to leave their family home until they have to. If elderly country folk also have to abandon their families to get the professional care they need, I doubt many of them will ever want to receive it. This bill therefore represents just another aspect of this government's cruelty to elderly Australians. Once again, the Howard government has failed to disclose the full implications of its initiative, thereby veiling it in uncertainty. Elderly Australians deserve some certainty when it comes to aged care. It is highly irresponsible of this government to continue to shroud its policies in ambiguity when the specifics are what ultimately will determine the impact on smaller service providers, particularly in rural and remote areas.

The government has continued to confuse and upset older Australians who are already reeling from the implementation of accommodation charges that have threatened the security of their family home. They continue to refer to `options' and `choices' as though older people choose to enter nursing home care on a whim. Often older people are forced into such `choices' as a result of sudden serious illness. The last thing they need is to be forced away from their relatives and friends at such an unsettling time. Therefore, the threat posed by the mystery accreditation fee is certainly real and quite substantial.

Adding to the uncertainty of service providers is the fact that this may not be the only new expense they incur. Accreditation under the act will be compulsory if they are to continue to receive government subsidies from January 2001. However, the Aged Care Standards and Accreditation Agency is a relatively new body that many service providers have not dealt with before.

The new accreditation procedure could result in some facilities incurring substantial costs before they can become accredited. Facilities may need to introduce new quality control and management systems, update IT systems or implement any number of changes as a result of the new regime. Imagine the implications this might have on smaller service providers. Not only will they have to come up with the accreditation fee, but they might also have to undertake significant expenditure to ensure they comply with the new rules. Surely it would have been more sensible to maintain funding to the agency under the Aged Care Act until service providers had time to adjust to the changes.

Some service providers have indicated that the full cost of accreditation could end up being around $50,000. This would certainly be enough to undermine the financial viability of those smaller facilities already teetering on the brink. The irony of this situation is that the agency set up to ensure standards in aged care might actually end up effectively undermining them. Even if smaller facilities survive the changes, the threat to services is not eliminated. If small providers are forced to institute new administrative and management procedures under the new system, they may have to reallocate funds set aside for services or capital spending. Therefore, funds could end up being diverted away from services for residents. This would certainly undermine the objective of ensuring service standards in the aged care industry.

Without being able to put a price on the fee, it is certainly difficult to gauge the extent of its potential impact. But then why would the government seek to make anything clearer at this stage? They have consistently sought to confuse the issue of aged care, refusing to be tied down on any details or specifics. This government have continued to keep Australians in the dark on aged care. Indeed, they seem reluctant to divulge even the most basic and necessary of information for the elderly. Even publications designed to make the changes clear are an exercise in ambiguity and deception.

Home & Residence Choices for Older People is a Department of Social Security publication designed to give the elderly practical information about their aged care options. This book was supposed to make the government's aged care changes clear so that older people could make informed decisions about their future. However, the 1997 edition of Home & Residence Choices for Older People was outdated within about four months. So rapid and confusing were the government's changes to aged care that even the department could not keep up with them. We are yet to see the 1998 edition of Home & Residence Choices for Older People. Obviously, the relevant departments are still endeavouring to fathom the changes. The point is that this publication was supposed to be an effort on behalf of this government to make the changes to aged care clear. It was supposed to clarify things, and yet it has succeeded in confusing the issue even further. The 1997 edition is worthless now and the department has failed to produce a new one.

DSS spent $24,000 on market testing alone for the 1997 edition. They must have thought it was an important publication then, so where is it now? And, if Home & Residence Choices for Older People is not available, where are older people supposed to get this information from? No wonder they are feeling worried and confused.

Perhaps the government should stop trying to rush through massive changes to the aged care sector and start to think about the impact they are actually having on the elderly within our community. Older people are more apprehensive than ever about entering aged care facilities of any kind. I find it particularly disturbing that this government seems reluctant to offer them even basic information that could reassure them.

The Aged Care Amendment (Accreditation Agency) Bill 1998 will serve to further undermine older people's confidence in the aged care sector as a whole. The government's blatant refusal to reveal the cost of the accreditation fee has left many smaller service providers in a position where they are unable to reassure residents. Surely this is unnecessarily cruel and unfair to both parties.

All of this is taking place within a framework that is completely untested. The accreditation process is being worked through for the first time and the effectiveness of the agency itself is yet to be assessed. Service providers are bound to incur all sorts of expenses associated with the implementation of the new accreditation scheme. It is highly inappropriate that the government is trying to force them to pay to participate in what is actually a trial of its own new system.

This government has done nothing but create confusion and disarray with its so-called reforms to the aged care sector. It has created and maintained an environment of uncertainty and apprehension and older people no longer know where to turn for help. They have been denied vital information about their aged care options and this measure will only serve to confuse the issue further.

Smaller country facilities will almost certainly be threatened by the implementation of the accreditation fee, yet this government will not even give them an indication of cost so that they might be able to assess and prepare for the implications. The government has not provided enough information about this measure to the people concerned; they are hoping to rush it through as an idea and determine the specifics later. This is simply not acceptable considering the potential implications, particularly for country areas.

The Howard government needs to stop approaching aged care issues in such an underhanded way if they are ever to restore any confidence in the sector. If older Australians need to access aged care facilities in times of illness or frailty, they should be able to do so with confidence and without trepidation. I will never support a measure that seeks to deny them that security.


The ACTING DEPUTY PRESIDENT (Senator Sherry) —Senator West.