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Thursday, 14 September 1972
Page: 1404


Mr WENTWORTH (Mackellar) (Minister for Social Services) -

I move:

That the Bill be now read a second time.

The purpose of this Bill is to give effect to the announcement made in the Treasurer's Budget Speech that the Government would legislate in this session to assist the provision of additional hostel-type accommodation for aged persons. Before I proceed to give details of how the Bill does this it might be helpful to honourable members if I explained the general context into which the measure fits.

THE AGED PERSONS HOMES NETWORK

Since 1954, when the Aged Persons Homes Act was introduced, the Government has been subsidising the building by religious and other voluntary organisations of homes for aged persons, originally on a one-for-one basis and since 1957 on a $2 for $1 basis. Three types of accommodation (all of which are, of course, run on a nonprofit basis) are eligible for subsidy: Firstly, self-contained units, where residents may live independent lives under normal home conditions; secondly, hostel-type accommodation, where residents occupy separate rooms, but have meals and other personal care services provided for them; and thirdly, nursing homes, where those who are no longer able to look after themselves receive eitherlight or intensive nursing care, as required-

Capital grants made under this legislation to date total over $150m, with the aid of which accommodation has been provided for over 45,000 aged persons - 23,000 of them in self-contained units, 17,000 in hostel-type accommodation and 5,000 in nursing accommodation. Grants made during 1971-72 reached the record level of $23. 8m, demonstrating the continuing and expanding success of this legislation.

I seek leave to incorporate in Hansard a table showing the present position and the advances which have been made in recent years.

Mr DEPUTY SPEAKER (Mr Lucock)Order!Is leave granted? There being no objection, leave is granted. (The document read as follows) -

 


Mr WENTWORTH - I am glad to be able to report to the House that in 1971-72 we broke records in numbers of beds approved in each of the 3 types of accommodation, and that preliminary figures suggest that 1972-73 may also be a record year, surpassing even last year.

PENSIONERS' HOUSING

Homes established under the Aged Persons Homes Act, of course, accommodate only a fraction of the aged population of Australia. Of our 834,000 aged pensioners, for example, departmental records indicate that over 519,000 or 62 per cent, live in homes which they themselves own. State housing authorities and unsubsidised hostels provide for at least a further 25,000 and approximately 40,000 are living in nursing homes which were not subsidised under the Aged Persons Homes Act, mainly those being operated commercially. Departmental records indicate that many of the remaining aged persons would be living, either with their families or relatives, under conditions they themselves would not want to change or in good-standard accommodation which they rent from private owners at a reasonable rate. A residue, however, would be living under unsatisfactory conditions; that is, either living in accommodation of an unsatisfactory standard or paying a rental that they are not able to afford. It has been estimated that as many as 50,000 pensioners may be living under these conditions. There is still scope, therefore, for further expansion under our Aged Persons Homes Scheme and the accommodation subsidised to this point of time could be doubled before reasonable needs could be said to have been met.

At the present rate of progress it would take many years to clear the backlog and, of course, in the meantime the need continues to increase. It has been estimated that the number of aged people needing satisfactory accommodation is increasing at the rate of 1,000 a year. The problem is not simply a matter of accelerating the rate at which accommodation is being provided under the Aged Persons Homes Act. It has become increasingly obvious that the need is not only for more accommodation, but for more of the right type of accommodation and for available accommodation to be directed more towards the people most in need of it. In other words, it is necessary to face up to the fact that an imbalance exists between the types of accommodation available to aged people.

It has been established through surveys carried out by the Department of Health, that many aged persons who have no real medical need to go into an institution are permanently occupying beds in nursing homes. It has been reliably estimated that this may be true of at least 12,000, or say, 25 per cent, of the patients in nursing homes throughout Australia. No doubt one of the causes of this situation is that, up to now, no alternative accommodation, of the type which really suits their needs, has been readily available. There are long waiting lists for most of the organisations under the Aged Persons Homes Act which provide hostel-type accommodation. At present there are over 51,000 nursing beds in Australia, nearly half of which are in New South Wales, and even at existing rates nursing home benefits are costing the Commonwealth over $78m a year. Before the end of 1973 the number of nursing beds is expected to rise to 55,000 and the Commonwealth commitment to over $100m.

More important than the financial consideration, it is sociologically bad for people to be put under care more intensive than they need. From the medical point of view they should be encouraged to exhibit the maximum independence. Nursing home dependence causes their sphere of activity and scope for normal living to be unduly curtailed. It is medically and psychologically bad to force old people, through the lack of any real alternative, to accept a nursing home regime when they have no real need to do so. The drain upon nursing and technical resources is also significant. The ratio of patients to staff in non-profit nursing homes is about two to one, which means that for every thousand beds about 500 staff are required, comprising 170 trained nurses, 200 nursing aides and 130 domestics. With nursing beds increasing at the rate of 5,000 per year this gives rise to an additional staff demand of about 2,500.

PENSIONERS AND NURSING HOMES

A number of reasons have been elicited for the growth of nursing homes. Firstly, the generous rates of nursing home benefits undoubtedly provide a great inducement for people to seek this type of accommodation. In effect they receive, even if only on the existing ordinary rate of nursing home benefit, a supplementary pension, free of any means test, of $24.50 a week; while for those on intensive care it is $45.50 a week. Both these figures will be substantially increased when the Budget proposals of the Department of Health become effective. Secondly, there is the lack of an effective system of screening admissions to nursing homes. As the house knows, the Department of Health proposes to remedy this situation.

Thirdly, there is the increasing and alarming trend in the community for families and relatives to look to nursing homes to solve the problem of accommodation and care for the aged. Many young couples today are either unable or unwilling to care for their aged parents, and look to the Government to find a solution to this problem. The introduction of the $14 a week extra payment for people who keep their sick relatives in their own homes, which again is proposed in the present Budget, and which will be under the administration of my colleague the Minister for Health (Senator Sir Kenneth

Anderson), will substantially ease the financial burden for those who assume or continue these family responsibilities. The fourth reason is by the relatively undeveloped state of home care services such as meals on wheels, home nursing and paramedical services, housekeeper and other home help, senior citizens centres, etc. In 1969 the States sought, and were given by the Commonwealth, matching grants to foster growth of these services, but growth is occurring very slowly. The Minister for Health and myself, as already announced, have obtained Cabinet authority to discuss with the States ways and means of accelerating this process and I trust it will not be very long before we can report some further progress to the House. The fifth reason for the unbalanced growth of nursing homes is the attitude of the States. Both nursing homes and home care services have traditionally been regarded as State responsibilities, but the States seem almost to have abrogated their responsibilities in the nursing home field and, in some cases, seem reluctant to assume their proper responsibility for home care services. Whatever the constitutional position, the Commonwealth cannot stand idly by and see the real interests of old people prejudiced by the failure of the States to face up to their responsibilities. The Commonwealth concern is the background to the comprehensive and balanced programme which I have outlined, of which the proposal in the present Bill is an integral part.

The contribution that the legislation I now place before the House makes to the Government's multi-lateral approach to the problem, is to provide added encouragement for religious and other voluntary organisations to build more hostel accommodation as quickly as possible.

The Bill provides for the Commonwealth to make grants to eligible organisations towards the building of hostel-type accommodation on the basis of existing homes which were built either without Government subsidy or when subsidy was available only on a dollar-for-dollar basis.

The Commonwealth will meet the capital cost of providing hostel-type accommodation for two additional aged persons for every one at present accommodated in an unsubsidised home, or one additional person for every two in an existing home subsidised on a dollar-for-dollar basis, up to a maximum of $7,800 for every aged person or necessary staff member accommodated.

The Bill also provides for grants of up to $250 per person to be made towards the cost of furnishing these hostel-type beds.

THE PROVISIONS OF THIS BILL

It will not be necessary for the organisation to make any monetary contribution to the capital cost of the new home unless the capital cost exceeds $7,800 per person, or the furnishing cost exceeds $250 per person, or the bed capacity of the new home exceeds twice that of the unsubsidised qualifying home, or half that of the qualifying home subsidised on a oneforone basis. The Bill provides that the qualifying home should be one which, unless the Director-General of Social Services otherwise determines, would have attracted a grant under the Aged Persons Homes Act if built recently. In exercising his discretion under this section the DirectorGeneral will make allowance for advances in the standards of aged persons homes which have occurred since the qualifying home was established. In accordance with the principle established in the Aged Persons Homes Act, existing homes which were established wholly with funds provided by State governments will not be eligible for approval as qualifying homes. However, where the capital cost of the home was shared between the voluntary organisation and the State, a proportion of the accommodation, calculated on the basis of the organisation's contribution, will be acceptable as the basis for a grant under this legislation.

The Bill also includes a requirement that construction of the new hostel must be substantially commenced within a period of 12 months from the date of approval of the grant by the Director-General of Social Services. Otherwise the approval shall be deemed to have lapsed. The object of this provision is to bring about the building of the new accommodation within a reasonably short period. The legislation will operate for a 3-year period only, commencing from the date on which the Bill receives royal assent. In order to ensure that the 'free' homes established under this Act provide accommodation for those most in need of it, it will be a condition of approval that the accommodation is to be allocated strictly on the basis of need, without any contribution being required or received from the prospective resident towards the capital cost of the home or the funds of the sponsoring organisation. Personal care subsidy, provided under Part III of the Aged Persons Homes Act, will be payable, subject to the usual conditions, to homes established under this legislation.

I would like to reiterate that the primary intention of the Bill is to stimulate the building of additional hostel accommodation in order to reduce admissions to nursing accommodation of people who have no real medical need for nursing care. In order to preserve this intention the agreement into which organisations receiving grants under this Bill will be required to enter will provide that Commonwealth nursing home benefits shall not at any time be sought for any beds in the hostels established under this special legislation, that no existing hostel accommodation which was established under the Aged Persons Homes Act shall be registered for the purpose of receiving Commonwealth nursing home benefits on the basis of this special hostel accommodation, and that a further grant will not be sought under the Aged Persons Homes Act towards the cost of establishing nursing accommodation on the basis of the hostel accommodation established under this new legislation.

As most honourable members will be aware, the cost of establishing nursing accommodation may be subsidised under the Aged Persons Homes Act on the basis of one nursing bed for every 2 ordinary residential beds. It is not intended to permit hostel accommodation established under the Bill now before the House to be taken into account in this way for the purposes of the Aged Persons Homes Act. It will be expected, of course, that organisations which receive grants under this legislation on the basis of existing homes will continue to use the 'qualifying homes' as accommodation for aged persons. It will be appreciated that this new legislation is not in any sense a substitute for the existing aged persons homes legislation. That existing legislation will continue to operate unaffected by the present Bill, which is a temporary addition, to cover the 3-year crash programme. It is in order to make this quite clear that the present Bill is separate and not drafted as an amendment to the existing Act.

THE IMPORT OF THESE PROPOSALS

It will be seen that the Bill will give some existing organisations the right to construct new hostel-type beds entirely out of Commonwealth funds, and without drawing upon their own resources. In adopting this principle in this particular case the Government has 2 considerations in view: Firstly, the organisations, by the past provision of beds before the present subsidy became effective, have already contributed their fair share, and secondly, the organisations concerned have no further need to prove their bona fides because by their maintenance of their charitable work over a span of years they have already given the most convincing proof. The organisations which will benefit under this legislation will include church organisations, both Protestant and Catholic, which for long have very properly been engaged in this charitable work. They will include voluntary organisations such as the Returned Services League, associations for blind people and a number of others. They will include charitable trusts which have long been established. These are the organisations which will be entitled to take immediate benefit under the provisions of this new Act.

The new beds in this crash programme are all to be of the hostel-type; no capital donation may be required from their occupants; and they are to be allocated strictly on the basis of need. In amplification of these stipulations, I would set out the following principles which we have adopted: In determining the allocation of beds in accommodation provided under this Act organisations will be required to ensure that the beds are allocated, as I have said, without donation either by or on behalf of the occupant or intending occupant, and in accordance with need. 'Need' is to be decided by the organisation concerned having regard to the following: (i) degree of frailty or medical condition; (ii) age of applicant, priority to be given to those in the upper age groups, that is over 75 years of age; (iii) existing accommodation situation - preference is to be given to frail elderly people living alone or those whose families can no longer accommodate or care for them for domestic, social or other reasons; (iv) financial position of the applicant. Other things being equal, preference is to be given to pensioner medical service pensioners, particularly those who cannot afford to meet the rental of the premises in which they are residing.

The programme is thus specifically tailored to achieve its objectives: First, the quick provision of beds of the type most needed; second, the allocation of those beds to those who are most in need of them; and third, the administration of those beds by the charitable organisations, which are best qualified to administer them.

OPPORTUNITIES UNDER THIS LEGISLATION

It is not possible at this stage to give a reliable estimate of the number of hostel beds likely to be brought into being by this legislation. Available information indicates that there are nearly 10,000 beds in unsubsidised homes conducted by voluntary organisations throughout Australia, but it is believed that a significant number of these would have been established with the aid of State Government grants and therefore would not qualify for the purposes of this legislation. In addition there are some 3,400 beds in homes that have been established under the Aged Persons Homes Act on a $1 for $1 basis in place of the present $2 for $1 basis. It is estimated that expenditure under the legislation could exceed $5m in the first full year. However, because an initial period is necessary for planning projects and calling for tenders, expenditure is not expected to exceed $2m in 1972-73, but it is my sincere hope that these estimates will prove to be overconservative.

This Bill represents only one part of the overall pattern of the measures being taken by the Government further to improve the position of our aged folk this year, but I feel sure that its importance will be recognised and applauded by all honourable members and by the churches and other voluntary organisations which have for so long been serving the community by providing much needed accommodation for the aged. I commend the Bill to the House.

Mr DEPUTY SPEAKER (Mr Lucock)Isit the wish of the House to proceed with the debate forthwith?


Mr Wentworth - On a matter of procedure I would suggest, Mr Deputy Speaker, that you might permit a cognate debate to be conducted of this Bill and the Aged Persons Homes Bill. Of course, separate questions would be put at the conclusion of the debate.


Mr Les Johnson (HUGHES, NEW SOUTH WALES) - Usually when a Bill is introduced members have the benefit of receiving a copy of the Minister's second reading speech. On this occasion the Government has prevailed on the Opposition to continue with the debate in order that pensioners can quickly benefit. I ask the Minister to utilise the resources of the House so that members of the Opposition can have the benefit of studying his speech.


Mr Wentworth - We are adopting this procedure at the request of the Opposition but I am very happy to have the Bills debated now. I think the honourable member has now received a copy of my speech. Will it suit the convenience of the Opposition to proceed?

Mr Hayden - Yes







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