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Thursday, 5 December 2019
Page: 5203

Senator GRIFF (South Australia) (09:38): People were shocked by the extent of the abuse and poor care exposed in the interim report by the Royal Commission into Aged Care Quality and Safety. It was a scathing report and an indictment on an industry that is meant to deliver respectful, good-quality care during an aged person's final years. The interim report showed that the government has deep systemic work to do to fix the aged-care system. It also needs to increase its investment. But it cannot simply pour money into the system without asking for a more accountable and transparent situation from providers. It cannot continue to tinker around the edges.

Centre Alliance supports the Aged Care Legislation Amendment (New Commissioner Functions) Bill 2019, as I'm sure every senator here does. The bill completes the process of handing responsibilities for aged care from the department to the Aged Care Quality and Safety Commissioner and its independent commissioner. It will put responsibility for approval of aged-care providers, plus complaints handling, accreditation, auditing, compliance and sanctions, under one body. This will certainly help streamline and strengthen oversight, as these roles will no longer be split between the department, the former Aged Care Complaints Commissioner and the Aged Care Quality Agency. But, as we all recognise, that's just one important step on a long road of necessary reform.

There are just so many problems in this sector. For instance, I started asking, over many estimates sessions, about what happened to unspent home-care package funds once a person passed away and was no longer receiving in-home assistance. What I discovered was that the department did not audit unspent funds. The department pretty much ran an honour system, where the onus was on providers to return unspent funds to the Department of Health. The department has since conducted a pilot audit of the program, which found a number of areas for improvement, but even then it did not look at the evidence of undisclosed outstanding unspent funds—incredible! That's just one example of the many problems in the mammoth aged-care sector.

The proper training of aged-care workers is another ongoing failure which the government knows about but seems to be doing nothing to tackle. Aged-care training for personal care workers is an absolute basket case. It needs to be better regulated and nationally consistent. For example, at the moment there are over 80 providers offering Certificate III in Individual Support. Some of them offer a course that runs for just 10 weeks, and others run that very same course for a year, which is actually the recommended minimum. It's patently clear that 10 weeks of study is not enough to learn and cement what a worker needs to know to deliver quality care. How can we improve the aged-care system if we don't massively improve training first?

Without a doubt, the sector also needs substantially more funding to ensure quality of residential care and faster ACAT assessments of care needs. The government needs to get assessment wait times, especially for home-care packages, down to one to three months instead of well over 12 months. Government is taking steps in this direction by making 10,000 more places available. But, as other speakers have noted, this is nowhere near enough to address the unmet needs in our communities. The health minister has also recently responded to the problem of chemical restraints by announcing that doctors will have to apply for permission to prescribe the antipsychotic drug risperidone for more than three months. However, it needs to be said that the overuse and inappropriate use of chemical restrains are a symptom of much larger problems in residential aged care, such as understaffing and poor staff training. These two measures are only small fixes that respond to the primary symptom and not the underlying causes.

The royal commission's interim report sounded a warning note on quick-fix responses. It noted that government policy in this area was beset by short-term solutions, which will:

… at best temporarily stave off the worst problems and, at worst, produce another set of unintended outcomes requiring further inquiries and reviews and further injections of public funds, without addressing the underlying causal factors.

Academic Juanita Breen, a dementia care researcher from the University of Tasmania, pointed out something similar in a piece in The Conversation last month. She cautioned that tightening access to risperidone may only serve to shift prescriptions to other sedatives. She also said GPs report feeling pressured by staff to prescribe these medications due to a lack of staff training on other ways to deal with these types of symptoms. Importantly, she made the point that we need to address training and the care environment, among other things, before we can properly address overprescribing of chemical restraints.

It's good the government is trying to act, but it needs to go deeper, to the root cause of the problems, which almost always go back to not having enough adequately skilled staff. Funding is a big part of the equation; we won't fix the system without better investment. But we can't be throwing more money at the problem without asking for more accountability and transparency from aged-care providers in return. That is what my amendments are all about.

Approved providers will have to provide annual financial statements to the Quality and Safety Commission, which will then make them public. The financial statements will detail the amount spent on the provision of care—things like food and medication—as well as the amount spent on staff and staff training, accommodation, administration and the amounts paid out to parent bodies. At the moment, there is no clear way to know how much a provider is spending on the provision of care. Is it 30 per cent of their income? Is it 50 per cent or 70 per cent? We just do not know how much a provider is pocketing as profit at the expense of the people in their care. At the moment, providers can spend their taxpayer subsidies pretty much as they choose. But, in an environment where our elderly are being subjected to systemic neglect, they very much must be held to account.

My office has heard firsthand accounts from people who work with and for aged-care providers highlighting that dodgy financial decisions and profiteering takes place. For instance, there is a hundred-bed provider that has made $2.5 million in profit three years running, but this profit is only shown as $500,000 on its financials, because they pay $2 million in rent to the parent company which already owns the building. And there is a 50-bed not-for-profit facility where the salaries for three managers exceeded $500,000 at a time when the home could not meet basic minimum standards and was also, as it turns out, sanctioned. And there are other providers using subsidies to help send senior staff to overseas award ceremonies and lavish conferences.

This amendment has the support of the Australian Nursing and Midwifery Federation, whose members are at the coalface. They and many other stakeholders want financial transparency so that it is finally clear how much facilities actually spend on delivering care and how much is pocketed or wasted.

The same day I circulated my amendment, I saw a story on the ABC about the royal commission's Hobart hearing which emphasised why these amendments are needed. That story detailed how Bupa South Hobart was so understaffed that, according to the daughter of two residents, her 90-year-old mother had been forced to clean up after her incontinent father and at times help a blind elderly resident go to the toilet because the woman's calls for help had gone unanswered. According to the ABC story, a former Bupa regional director said there was pressure on the facility to spend less on staffing. Part of her responsibility was to 'improve the commercial operation in South Hobart'. In other words, her job was to increase profits.

My amendments are all about transparency and accountability—and, boy, do we need more of this! For this reason, we also intend to support the Greens amendments, as they deal with disclosure of information. The Centre Alliance amendments also reflect a private member's bill introduced by my colleague Rebekha Sharkie, which would simply require aged-care providers to disclose their staff ratios.

Knowledge is power, as they say. All of these amendments seek factual information from providers so we will have a clearer picture of how their facilities are resourced. This will be crucial if we are to engage in sustainable reforms to the sector that will improve the experience and treatment of vulnerable elderly people living in residential aged care. I urge all senators to support these important amendments.