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Tuesday, 19 August 1980
Page: 385

Mr HOWE (Batman) - The Opposition supports these pieces of legislation. They are designed to strengthen the capacity of the Commonwealth to intervene in situations where nursing homes are deficient with respect to their financial records. The measures can be seen within the context in which successive governments have sought to ensure that the substantial Government support provided to nursing homes results in the maximum benefit to the patient and not in excessive profits for those homes which are run on a profit-making basis. My own view is that health care should not be operated on the basis of profit. I think further that this area of nursing home care where such a high proportion of the patients are on pensions should ultimately be excluded from institutions which are run on the basis of profit.

It is unfortunate in this country that the medical profession is so orientated to the principles of free enterprise capitalism and therefore so strongly opposed to reforms in the health care system which would seek to reduce profits or to transfer services to not-for-profit institutions. For example, the Australian Medical Association fought a bitter campaign in 1973 to oppose reforms which were introduced by the McMahon Government and administered by the Whitlam Government which would have had the effect of restricting Commonwealth subsidies with respect to nursing homes to those patients who were pensioners with pensioner medical service entitlements. This reform of course meant little in terms of financial savings as it was subsequently established that the additional pensioner benefit was paid in respect of 87 per cent of all nursing home bed days, a fact which also highlights the dependent economic status of the inmates of nursing homes.

The AMA also opposed the Government's attempt to restrict entry of people into nursing homes by making it a condition of entry that intending patients be examined by a Commonwealth medical officer. With the introduction of emergency procedures this reform was to become generally accepted within the community as worthwhile. As Scotton has pointed out, nursing homes must be looked at in the context of a much broader range of policies concerning the care of the aged and it has to be recognised that government policies have placed too much emphasis on institutional care and too little on domiciliary and other services.

Despite the fact that since 1969 successive governments have sought to redress the balance by subsidies to alternative services and types of accommodation, legislation has covered for example paramedical services, home help, delivered meals, personal care in hostels, cash benefits for caring relatives, senior citizens centres and subsidies for hostels and self-contained units, it would seem that we have advanced very little with respect to the fundamental problems which were being identified a decade ago. Indeed, the trends towards a greater proportion of the population being in the aged category and the tendency for people either to retire earlier by choice or be forced out of the workforce at an earlier age is likely to exacerbate the problems we will have to face in the 1980s. In part these problems flow from the fact that successive conservative government, with respect to welfare, have been, in the words of Hugh Stretton, amongst the meanest in the Western world.

One wonders what the situation of aged people in this country would have been if it had not been for the Whitlam Government substantially raising the level of aged benefits. Professor Henderson found that 36 per cent of single aged males and 31 per cent of single aged females were poor. But then the less politically powerful groups dependent on welfare such as the unemployed have a sense of what that would have meant. Again, the only reason that unemployment benefits for dependent adults are at reasonable levels is because of the changes introduced by the Whitlam Government. The young unemployed and the people without dependants have remained in poverty for most of the period in which this Government has been in power. The attitude of the Fraser Government towards people dependent on welfare services can be summed up in its five years as harassment of the unemployed which marks it with a shame which will endure for years beyond its impending defeat.

Mr McVeigh - I raise a point of order, Mr Deputy Speaker. In a spirit of charity - has unemployment got anything to do with nursing homes? I suggest that the honourable member stick to the point of the Bill.

Mr DEPUTY SPEAKER (Mr Millar - The Chair upholds the point of order. It has extended tolerance to the honourable member for Batman but he seems inclined to persist with his line of debate. I ask him now to be relevant to the Bills before the House.

Mr HOWE - With respect, I think the Bill is concerned to curb excessive expenditures under the legislation in a way which would result in the misuse of funds that would be allocated by the Commonwealth to nursing homes. Within that context I think it is not unreasonable to refer to other measures that the Commonwealth has taken to restrict spending broadly within the--

Mr Lloyd - I raise a point of order, Mr Deputy Speaker. Does that mean that the honourable member is saying that to pay money for unemployment benefits is a misuse of funds?

Mr DEPUTY SPEAKER -Order! The honourable member for Murray has not yet received the call. I call the honourable member for Murray on a point of order.

Mr Lloyd - The point of order I raise is: Does that mean that the honourable member who is speaking now indicates that for the Government to spend money on unemployment benefits is a misuse of government funds?

Mr DEPUTY SPEAKER - There is no point of order.

Mr Lloyd - Well, that is what he is saying.

Mr DEPUTY SPEAKER -Order! The honourable member for Batman may proceed and be relevant to the Bills before the House.

Mr Cohen - Keep that mob of thugs up there in the corner in order.


Order! The honourable member for Robertson who is not occupying his proper place will acknowledge that the language is unparliamentary.

Mr McVeigh - Ask him to withdraw, Mr Deputy Speaker. That is in order.

Mr HOWE - Mr DeputySpeakerMr McVeigh- Ask him to withdraw, Mr Deputy Speaker. He should stand up like a man.

Mr Cohen - I withdraw.

Mr DEPUTY SPEAKER -The honourable member for Darling Downs will remain silent. The honourable member for Batman will continue.

Mr HOWE - I was seeking to put the subject matter of this legislation within admittedly a rather broader context in terms of government social policy as it affected people dependent on social security benefits of one sort or another, of which the nursing home benefits which are covered by this legislation are an example. I think in this context that is not unreasonable. I take up here a point that was made by the honourable member for Bonython (Dr Blewett) before the suspension of the sitting for dinner, which is to say that these particular piecemeal reforms in relation to nursing home administration and nursing home benefits represent reforms which do not necessarily go the heart of the issues which concern the aged and particularly the question of accommodation for the aged. I was going to suggest that this Government had certainly been extremely punitive in certain respects, particularly in relation to the unemployed. But I make the point that this Government- and I think, this legislation illustrates the point I want to make - has been singularly unimaginative in its whole approach to the question of social policy. Quite clearly, over a long period it has been recognised that a policy which is directed towards institutionalised care for the aged is a policy which has built into it certain fundamental deficiencies and that the emphasis needs to shift - I think successive governments have at least given lip service to this - from institutionalised accommodation as the prime emphasis in relation to the care of the aged towards a more comprehensive program of community based treatment.

I think the honourable member for Bonython was suggesting earlier in this debate that a Labor Government would certainly seek over the longer term to work towards a situation whereby a comprehensive approach was developed for the care of the aged, whereby there was a real choice for aged persons between one system which is currently dominated by institutionalised care of one sort or another and different types or different patterns of care so that we were able in a sense to make reductions in the overall costs associated with health care, but at the same time were able to create a situation whereby as people moved towards a later stage in life, they felt they had a real choice. It is widely recognised that institutionalisation is not the best solution for many of the aged. Whilst it appears to families that they have met their responsibilities for aged relatives, for the aged themselves shifting into an institution is the greatest crisis they have ever had to face. But it becomes an acceptable alternative when families cannot care for them and their diminishing physical strength and health makes them fearful of the future. The 1975 Commission of Inquiry into Poverty, in referring to the aged remarked:

Experience has shown that such a change of environment is associated with anxiety and disorientation. The effect can be to reduce the expected remaining years of life. For those who do adapt to change they exist rather than live.

That point made by the public inquiry is extremely important and ought to be underlined. There are thousands of people currently in nursing homes and hostel accommodation for whom that type of accommodation is singularly inappropriate. But once they are placed within that total institutional context, in a sense their capacity to move out of it is progressively diminished over time. That means that people who have a capacity to be independent within this type of accommodation very often are made rapidly dependent. Indeed, the kind of subsidies that are provided to institutions that have very often as their object the making of profit are specifically designed to encourage people to remain within institutional care rather than for people to achieve the maximum degree of independence for which they are capable at a particular stage of life. That is the major point I want to stress in this speech.

In 1977 the Holmes Committee reported on the care of the aged and infirm and pointed out that the aged were taking a larger and larger share of the Federal Budget while, and I quote from the report: their standards of accommodation and services had shown little real improvement.

The Committee suggested that despite large sums of money spent by the Commonwealth on income and service support there were still large numbers of people lonely and destitute. Many areas lack even rudimentary domiciliary care programs and long lists remain of people wishing to enter nursing homes. The Committee pointed out the causes of these problems as being largely the ad hoc way in which this program was developed. That point does not refer simply to the legislation that we have before us tonight but to the whole package of legislation that has been developed to take care of a range of services provided for aged persons.

Secondly, there is a lack of co-ordination between various levels of government. I believe this to be a critical problem in this area. I have been very surprised that a government which made so much of that issue in 1975, and more recently received a major report, the Bailey Commission report, on the subject has not acted at all on that point and has not moved towards increasing the co-ordination that exists between the three levels of government which are necessarily involved in delivering services to aged persons. Thirdly, in the past, concentration on institutional accommodation has been the pattern, rather than a concentration on the development of comprehensive domiciliary services.

Finally, there is an absence of effective assessment and rehabilitation procedures which could more efficiently match services to needs. Despite improvements that have been made in the legislation in the past, to which I referred earlier in my speech, the reality is that we do not have very often at the local community level the capacity to make an assessment of just what type of care people may need at a particular stage in their lives. The result is that we have people located in a type of accommodation which is not only more expensive than perhaps they may need, but also very often is the type of accommodation which results in people having a deteriorated capacity, rather than an increased capacity, to look after themselves and to live a relatively independent life within a local community.

Quite clearly, if one is to resolve these problems, a comprehensive community care program is required which will enable existing nursing homes and accommodation services to be coordinated into a wide-ranging, far-reaching community based program. It should be recognised how important the nursing home is within the context of psychiatric treatment, particularly in care following a period in a mental institution. The Commission of Inquiry into Poverty which reported on the social and medical aspects of poverty cited studies undertaken in Sydney which show that a very high proportion of people leaving psychiatric care go to nursing homes. It referred also to statistics which show that a very high proportion of older psychiatric patients returned to hospital for further inpatient treatment. Health workers in my electorate are extremely critical of the quality of care being provided in many nursing homes and hostels in which they are forced to place people who are discharged from psychiatric hospitals. There would appear to be many deficiencies within these institutions not only with respect to the quality of diet but also, even more seriously, with respect to the type of program, or the lack of any kind of therapeutic program, which might assist people to remain active and to keep open the possibility that they will return to live within the normal community.

While this legislation, which is currently before the House, may do something to tighten up the standards it, of course, is a negative measure which does nothing to move towards the situation of comprehensive community based care which should be provided. The problem with this Government is illustrated by its obsession with saving money which is illustrated in the current club, a paraplegic campaign being organised by the Department of Social Security. It lacks any real sense of vision or any sense of where it is going in terms of long term programs and long term care for important groups in the community such as the dependent aged. The Government in supporting without significant alternatives the total institution mentality is, in fact, providing a formula for greater expense in the long term. However, the reality is that the alternatives which might provide long term savings are not cheap either. I believe the establishment of community health centres both of the general and psychiatric type represent a major step towards providing a basis at a local community level of comprehensive community care systems. However, this Government has resisted the expansion in this system and has most recently announced that it was cutting back funds for community health centres this year by 1 0 per cent in real terms.

Mr DEPUTY SPEAKER (Mr Millar)Order!The Chair has extended considerable latitude to the honourable member. I ask him to make his remarks immediately relevant to the Bills or alternatively to bring his remarks to a close.

Mr HOWE - 1 think I am speaking with relevance to the Bill. I am talking about nursing homes within the context of the comprehensive community care systems.

Mr DEPUTY SPEAKER -Order! The Chair rules that the honourable member is not being sufficiently relevant. A passing reference to the matters that the honourable member mentions may be acceptable, but he persists with his remarks that are not relevant to the Bills.

Mr HOWE - The reality is that there can be no solution to problems posed by nursing homes without radically different approaches which, at least, need to be initiated by the Commonwealth in terms of the development of national policy and provision of some incentives to work towards that policy. If the Commonwealth fails to move, the result will be that more resources will be absorbed in new capital funds for expensive institutional care and fewer resources will be available for the community based care that everyone agrees ought to be the greatest priority. More seriously, there is a need for a fundamental rethink about the aged, particularly in the light of the increasing proportion of the aged in the population which we can expect over the next several decades. Some services for the aged could be provided cheaply and easily. For example, I recently held a meeting of representatives of various institutions and groups serving the aged in my electorate. It was quite clear that the major priority that people at that meeting had was the need for simple local transport systems which would enable aged people to move from their homes or from institutional accommodation, such as nursing homes, to participate in normal community activities such as shopping, attending clubs or local concerts or activities just where people could feel part of the community. At the same meeting a number of people who were living in their own houses suggested that assistance with simple repairs around the house was also a major priority. In fact, at the same time as people are talking about these kinds of needs, we find the Government funding expensive capital requirements.

Mr DEPUTY SPEAKER -Order! The honourable member's time has expired. The honourable member will resume his seat.

Question resolved in the affirmative.

Bill read a second time.

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