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Tuesday, 17 September 2019
Page: 2442


Senator SIEWERT (Western AustraliaAustralian Greens Whip) (18:17): I rise today to speak on the Aged Care Amendment (Movement of Provisionally Allocated Places) Bill 2019. This bill grants the Department of Health the ability to allow approved residential aged-care providers to move provisionally allocated residential care places from one region to another within the state or territory. Provisionally allocated residential aged-care places are residential aged-care places that have been allocated but are not yet operational. Under current practice, the Department of Health has considered applications from providers for the movement of places between regions; however, the Aged Care Act does not permit a variation of the region to which places are provisionally allocated.

This bill seeks to rectify this gap in the legislation and align it with the current practice in relation to the movement of places. The changes are required because it's reflecting more current practices about the way residential places are allocated and the way they're taken up. We have seen a lot of other reforms in the aged-care space, and there will be more to come in the future. The Australian Greens support this particular bill; however, we continue to have concerns about aged care in this country, and I think that these issues are not being adequately addressed and need to be adequately addressed. I'd just like to take this opportunity to focus on some of these issues.

The aged-care workforce is, unfortunately, still crying out for significant reform and investment. Although the

Community Affairs References Committee held an inquiry into the future of the aged-care workforce in this country and a strategy has been developed, we still don't see, a Senator Sterle just pointed out, this strategy being properly implemented. We still don't see the very important issues being addressed. We know that we're going to need around one million direct care workers by 2050 in this country. We are not doing enough to implement those recommendations and we need more urgent action to address these particular issues.

Personal care attendants now make up 70 per cent of the direct care employees in residential aged care. In contrast, the proportion of registered nurses has declined from 21 per cent in 2003 to around 15 per cent in 2016. Now, I know many people argue that aged care is not a clinical care setting. In fact, an inquiry reported just very recently about clinical care and aged care. Some aged-care providers seemed to argue that they do not provide clinical care, which is patently not true. So, at this time, there are even issues as to whether and to what degree aged-care facilities provide a level of clinical care. There are a number of issues that still need to be addressed, as was highlighted in the Senate inquiry.

Residential aged care is going to continue to evolve, given that people are living longer and they're going into aged care with much more complex care needs. We need to make sure that we have a workforce prepared for that. We're also not adequately addressing, in my opinion, dementia care. We are not providing enough—what's the right word?—encouragement for residential aged-care providers to make the changes that are needed to properly address dementia care in residential aged care. I'll come back to that in a minute, because it also relates to the continued use of physical and chemical restraints, an issue that I have some very serious concerns about.

Going back to staffing and the skills mix, the National aged care staffing and skills mix project report recommended that the amount of time for care required to prevent premature deaths and provide a safe environment for residents is four hours and 18 minutes per day, yet the national average time for care provided to aged-care residents is around two hours and 50 minutes per day. Clearly, there is a gap between the level of care that is considered optimal and what is actually provided. The research shows there is a relationship between the quality and quantity of staff and clinical outcomes for aged-care residents.

Staffing ratios can improve the quality of care, reduce unsafe work practices and lead to better outcomes for residents. There's currently no requirement for minimum staff-to-resident ratios in aged care. It is time that we looked at the research supporting staff ratios in aged-care facilities, especially around having one registered nurse rostered on 24/7. This issue needs to be addressed for the reasons that I articulated earlier. It's not just about having adequate staff numbers but also about ensuring the staff and the workforce are adequately trained, paid and qualified and that the staff actually meet the needs of the residents at the time. I appreciate that ratios can be difficult to deal with, but we need to make sure that we have the staff ratios on board to meet the particular needs of residents.

Some of the major issues facing the sector include high turnover of staff, difficulty attracting staff, undervalued jobs, casualisation of the workforce, skill gaps and lack of career progression. Aged-care workers often work in facilities experiencing chronic understaffing. In some cases this is leading to people not receiving the most basic care, thereby leading to preventable deaths. We are hearing, unfortunately, tragic outcomes of this in the current Royal Commission into Aged Care Quality and Safety. We need to do a lot better and to build and maintain our aged-care workforce, particularly with an eye to the future.

I touched briefly earlier on the issue of chemical and physical restraints. A key area for reform that the sector is currently grappling with is this particular issue in aged-care facilities. It is widely acknowledged that psychotropic medications which are used to chemically restrain people are overprescribed in aged-care facilities. The data shows that 20 to 28 per cent of aged-care residents are prescribed a regular antipsychotic every day and one-quarter of residents are prescribed benzodiazepines daily. Both physical and chemical restraints are being used to manage behavioural issues. This is incredibly risky, as all sedating psychotropic drugs increase the risk of falls and pneumonia.

The Parliamentary Joint Committee on Human Rights is currently investigating the new government regulations on the use of physical and chemical restraints. We have great concerns that these regulations do not go far enough, and I echo the concerns of Human Rights Watch that restraints should never be used for control, punishment, retaliation or as a measure of convenience. These restraints should only ever be used as a very last resort. There is an emerging, growing body of evidence of behavioural strategies and interventions that can be used to manage the underlying causes of challenging behaviour. These include environmental measures such as improved lighting and signage, psychosocial measures such as the provision of sensory aids and appropriate sensory stimulation, a care approach such as individualised routines and increased supervision, and physiological measures such as nutrition and hydration management.

As I articulated, there's a growing body of evidence on the sorts of measures that can be taken, including cognitive behaviour management and design of facilities. I have seen a number of these. I've seen very good care which has overwhelmingly reduced the number of physical and chemical restraints that are used, so this is possible, and I think we need to be doing a lot more encouraging of aged-care facilities to make sure they're implementing these processes instead of relying on chemical restraints. We must ensure that all facilities are implementing best-practice standards that allow older people to live in a safe, secure and home-like environment and move freely without undue restriction. We shouldn't be using these sorts of restraints as a measure of convenience.

I'd like to briefly touch on aged care for First Nations people. Our First Nations people are ageing at a much faster rate than the non-Indigenous population, yet we know they face significant barriers to accessing aged-care services. The government should be addressing these. These are both in the remote communities and also in urban communities, and people's cultural needs are not getting met. The cultural inappropriateness of many of the aged-care services is a key barrier to accessing appropriate services. Community engagement and cultural support are key to supporting our older First Nations people in aged care, and the aged-care royal commission has, unfortunately, heard a lot of accounts of First Nations people struggling to receive culturally appropriate, adequate aged care. At one hearing we heard how Torres Strait Islands nursing home residents are being denied access to traditional food while in care. In Darwin, the royal commission heard of an Aboriginal lady being forced to move 800 kilometres from her home to a centre in Darwin. She gave evidence to the commission and said: 'Can I ask for aged care in remote communities? We don't have aged care.'

Given what we know about the importance of community for First Nations people regarding aged care, all-too-common situations like these, where people have to move hundreds of kilometres from home for aged care, are particularly harmful. We need to reset the relationship with First Nations people across this country and across many issues, including aged care. We need to make sure that First Nations aged care is community controlled and is designed and delivered by First Nations people and that First Nations organisations are delivering culturally appropriate aged-care services.

Another barrier felt acutely by First Nations people is the poor provision of dementia care, which I've just touched on. We need a particular focus for First Nations people, who experience dementia at rates three to four times higher than non-Indigenous people do. That puts a whole other focus on how we deliver aged care. There are many, many issues that we are facing in the field of aged care in this country. We have an ageing population with growing expectations and needs. People are sicker as they go into residential aged care.

We support this legislation but consider that we need urgent action on so many issues, including mental health. The government has moved to allocate additional funding for mental health in residential aged care, and I acknowledge that. I'm extremely concerned about the way that is being delivered, in a patchwork of measures across the country, because it's being delivered through the PHNs. I'm not having a go at the PHNs, but we don't have a consistent approach across the country. From what I have heard, through talking to many, some of the services being delivered are better than others, but at the moment we are not guaranteeing adequate mental health care for those in residential aged care.

We need to lift our game on residential aged care. We've heard through the royal commission the now depressingly familiar accounts of people's lived experience. We need to do things differently. We need to lift our game. We need to make sure that we have a system that is fit for the future. Issues that have recently been aired in the media about the services delivered by Bupa, for example, should send a very strong signal both about the way our services have been delivered and that we can't continue going down that path.

We support this legislation. We'll monitor its implementation and continue to help and critique the delivery of aged care in this country. We'll then push for more reform in light of the recommendations that come from the royal commission. But the royal commission cannot be used as an excuse not to take action when and where it's needed before that process.