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Thursday, 17 November 1983
Page: 2919


Mr LEO McLEAY(9.08) —This evening we are addressing ourselves to the Health Legislation Amendment Bill (No. 2). In the short time available to me I shall deal only with those matters relating to the changes in the Government's nursing home program. I am pleased to support the Minister for Health (Dr Blewett) in regard to this Bill. I was rather surprised to hear the Opposition spokesman for health say that he is worried about the provisions the Government has brought in in respect of the growth of nursing home approvals and by moving the approval for nursing home beds from a bureaucrat to the Minister. I got the firm opinion from the shadow Minister that when he was in government he intended to do just those things.

There is no doubt that in Australia there has traditionally been a vast imbalance between the appropriations for nursing home beds and community care facilities. In fact we have one of the highest ratios of nursing home beds to aged population of any country. One has to look at why that imbalance occurred and at the steps governments need to take to rectify it. I suggest, as the House of Representatives Standing Committee on Expenditure, of which I am Chairman, suggested when it brought down its report entitled 'In a Home or at Home', that the main reason for the imbalance was the mechanism adopted by governments for approvals. The Minister most specifically is rectifying that approval mechanism in this Bill.

In the past, if the Government wished to increase the appropriation for home care programs the matter had to be deliberated upon in the Budget Cabinet. However, approval to increase the payments to nursing homes or approvals for nursing homes did not even have to be given by the Minister; the job was done by the Director-General of Health. To give the honourable member for Mackellar (Mr Carlton) his due, in his dying stages of his administration of the Department of Health he attempted to bring that matter under ministerial control. That was a commendable attempt but it came far too late. The statistics show that in 1976- 77 the Commonwealth appropriated $285m for institutional care. In 1982-83, the year of the last health budget presided over by the honourable member for Mackellar, the Commonwealth appropriated $848m for institutional care. In the same time, Commonwealth payments for home care rose from $32m in 1976-77 to only $77m in 1982-83. I suggest that the only reason for that imbalance was the mechanism of appropriation. The present Minister for Health is making sure that that does not happen in the future by providing in this legislation for the Minister rather than a bureaucrat to make those decisions.

Nursing home beds will have to compete with home care programs in the Budget discussions. They will be on a par, which has not been the position in the past. I think the provisions proposed by the Minister to restrict nursing home bed growth will go a long way to providing more facilities for older Australians. My Committee found-I am sure that other members would agree-that very few people would choose to enter a nursing home. If given a choice between going into a nursing home and going into a hostel and having the same assistance provided to them, the vast majority of elderly Australians would choose a hostel. Governments cannot restrict nursing home growth and not increase provisions for hostels. This Government has taken that view. While we have put a restriction on the growth of nursing homes, we have increased funding for hostels. The savings which occur from the restriction of nursing home growth will ensure that more money is available for hostel approvals.

However, I do not think the important thing is to have cost savings. Surely in this area of care for the aged we should be looking at what is most appropriate and desirable for the people with whom we are dealing. These people have gone through the Depression and the Second World War and have participated in the economic development of Australia. Surely they can look forward in their old age to the Government allowing them some dignity and allowing them to live out their lives in the manner in which they desire. I am sure that most of them would not like to live out their lives flat on their backs in a nursing home bed for which the proprietor receives the extensive care benefit. I am sure that hostels are far more appropriate institutions to provide that type of care. When the Auditor -General undertook an inquiry into the nursing home function of the Commonwealth Department of Health asserted that for 25 per cent of patients in nursing homes the level of care needed was lower than that provided.

I suggest to the House that nursing homes were becoming a very expensive accommodation project for the previous Government. People were going into nursing homes because they were homeless. They were taking on that very expensive type of care when they did not need it. Why did that occur? It occurred, in my view, because of the lack of diligence on the part of the Commonwealth Department of Health. My Committee looked at one run of statistics which showed that of, I think, 149,000 applications for admission to nursing homes in New South Wales over a number of years only one was rejected. One would not think that that level of probability would apply to those ineligible for admission to nursing homes.

The Minister put forward legislation earlier in this session and has now proposed amendments to the Health Act to allow the Government to institute assessment teams. These teams will ensure that the level of care people receive is matched to their level of necessity. As I said earlier, there is absolutely no point in admitting to a nursing home an ambulatory person who is cheerful but may have some slight disability when that person can be catered for far more competently and with greater personal benefits in a hostel. An assessment team will not be a big brother, as is somehow suggested by the rather more raucus members of the Opposition. In the words of the Minister for Health, the role of the assessment team will be to guide the people through the labyrinth. I think that is the most reasonable way to describe the assessment teams. The role of assessment teams will not only be to assess a person's eligibility for entry into a Commonwealth subsidised facility but also to provide advice to the person himself, his relatives and his general practitioner. These assessment teams are now in place and operating in many areas. The amendments in this legislation to provide for allocations for that purpose will ensure that people get a better deal.

I spoke earlier about hostels being the vehicle by which we should provide an alternative method of care. I think, however, that when we look at providing more hostel accommodation we should not make the mistake that was made a number of years ago in providing sick bays in hostels. A number of hostel operators, both voluntary operators and those operating for profit, put to my Committee that all they needed to cater for many more people than they do at present was a couple of nursing home beds. I think if the Commonwealth ever allows that type of hybrid to come to pass again, it will only compound what occurred in the growth of nursing homes in the 1960s. The Government should resist at all turns and prevent that type of growth. Hostels are available for people who need some sheltered accommodation but who in the main can look after themselves, and that is what they should be for. They should not have attached to them some sort of halfway house between the hostel and the nursing home.

I have been disturbed recently to see that a number of hostel operators are starting to charge people an entry fee or key money to get into their hostels. That unfortunate circumstance exists in retirement villages and the type of accommodation which is provided by the Commonwealth. I think the Commonwealth should ensure that it does not continue to occur in hostel accommodation. Hostel accommodation should be available, as is nursing home accommodation, to all those who need it, not only to those who can afford it. I believe that we should be making some assessment of those institutions or organisations that charge key money for entry into hostels and that, if possible, we should put a stop to that practice.

In conclusion I raise two matters quickly. I know that a number of my colleagues want to contribute to this debate in the short time available. I am interested to see that the Minister in this amending legislation is starting down the line of providing protection for patients. This Bill will provide the power to curb some of the excesses of nursing home operators. I must agree with the honourable member for Mackellar that such operators are a minority, but some nursing home proprietors are taking advantage of their patients, in some cases considerable advantage. The provision the Minister has proposed to protect those nursing home patients who have given a power of attorney to a proprietor will go some way to putting a damper on many of those rorts that were found to be occurring in the industry. The House of Representatives Standing Committee on Expenditure, of which I am Chairman, suggested to the Government that it should set up a nursing home tribunal. The Government should look seriously at enacting legislation to set up such a tribunal because if any group in the Australian community is powerless, it is most certainly the group of people in sheltered accommodation such as nursing homes. Their problem is that once they have entered a nursing home, in most instances there is no way out. Having sold off their assets, they really are in the position that they have all their life's belongings in cubicles beside their beds. Once they have done that it is very difficult to get out of the nursing home. Those people are very much in the power of the proprietor or the voluntary organisation running the home. There needs to be some independent inspection unit. There needs to be an organisation to which proprietors, relatives or even agitator groups can appeal about some of the inequities that occur in a number of private nursing homes. A nursing home tribunal would confidentially receive complaints and would have the power to act . At hearings before my Committee 18 months ago I was pleased that the Private Hospitals and Nursing Homes Association of Australia, the people who represent the private entrepreneurs, said they would be happy for that sort of tribunal to be formed. Indeed, Mr Gillroy, of the Australian Nursing Homes Association, said that he felt such a tribunal should have the power to fine proprietors who did not comply with the directions of the tribunal. While the Government is keen on consensus, we ought to look at that agreement from the entrepreneurs and form that tribunal so that people who have relations in nursing homes can make confidential complaints without their relations being discriminated against or being asked to leave because of the complaints.

In conclusion, I commend the Minister and the Government on this legislation. It goes some way to implementing the Government's election promise to give a fairer deal to those people in need of sheltered accommodation in their declining years. The removal of the emphasis on nursing home accommodation will for a change allow people a real choice. I find it most difficult to understand the previous Government's much vaunted commitment to freedom of choice when one considers that in the nursing home area there was absolutely no choice. When a person got old, sick and infirm and needed care the only real choice for that person was a nursing home. The amendments which the Minister has introduced change that. With the Government's community health program and extended care program, old people in Australia in the future will have a choice. I commend the Minister on these amendments.