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Thursday, 17 November 1983
Page: 2925

Mr COWAN(9.44) —We have to appreciate that over the years in Australia there has been a very great increase in the services available for aged care within the community. When we consider the Health Legislation Amendment Bill (No . 2) which is before the House we must keep that in mind. As the shadow Minister for Health, the honourable member for Mackellar (Mr Carlton), said earlier, there is a great need today to increase the services available and to come to grips with the problems that exist in aged care. When I speak about problems I refer to those of the Commonwealth and the States which cross each other's paths in providing this care. I trust that the legislation before the House will be a start to a much better arrangement between the Commonwealth and the States in providing accommodation for the aged.

I appreciate that the Government has been considering for some time what its future policies should be. I know that committees in my electorate have been raising money for quite a period. They are anxious to obtain approval for Commonwealth grants on a one-third to two-thirds basis towards hospital units or nursing homes. They have not been able to proceed simply because the Government has been unable to make up its mind about its policies. I do not criticise the Minister for Health (Dr Blewett) for this. A committee was set up to report on what that policy ought to be and the direction in which the Government should go . As I indicated earlier, problems will be involved in providing future care for the aged. But I trust that the policy-this is the first indication of the new policy of the Government-will be directed towards providing proper care for aged people and developing the wish of the Government to care for the aged in hostels and at home.

I do not think there is any conflict between the Opposition and the Government in thinking that we should as much as possible keep our parents, our uncles, our aunties and our aged relatives in their own homes, in their children's homes or in their friends' homes as long as it is possible to do so. But we have to be realistic. We have to appreciate that in many cases people do not have friends or relatives who are able to care for them, financially or in other ways. Many of our country towns in Australia do not have services available, either through district nurses, social nurses or hospitals, to care for people within the community.

There is one group in the community whose work we must all fully appreciate. Approximately two-thirds of care for the aged is provided in private institutions. The other one-third is sponsored by the deficit funding scheme for nursing homes, and is paid for by the taxpayer. Public groups are formed within the community, sometimes through the church, to raise one-third of the cost of the erection of a building and to gain the approval of the Commonwealth and the States to operate a nursing home. I would not like the Minister to impose certain bureaucratic controls that could effect the proper operation of private nursing homes or hostels. This is very important.

One of the successes with nursing home accommodation, particularly in country electorates such as mine and those of the honourable members around me, is the fact that those homes have been operated by local people. They have been operated by people elected by the community. They have gone to the service organisations and said: 'We want to collect money'. They got the money because they were enthusiastic enough to do so. They built the homes with the assistance provided by the Government and they conduct the homes under the regulations set down by the Commonwealth and the States. These institutions have been tremendously effective. I cannot criticise any that I know intimately within my own electorate or anywhere else in New South Wales. I never hear any complaints about them. I emphasise that they are conducted by local people. They are efficiently run and they provide a wonderful service that is so necessary for aged people within the community. I do not think that that should be overlooked in any way by the Minister or the Government.

It has been suggested that the Government should put advertisements in the Press asking: 'Are local people interested? Is there a need here for a nursing home?' If those advertisements appear in the Press, the response will not be a true reflection of the community. As I said earlier, people within the community see the need themselves. They combine to raise the funds. If it were left to the Government to put an advertisement in the paper, people may not be alerted to it and may not be able to find out who wants to be in a nursing home. I think bureaucracy will intrude and people in departments will recommend that so many aged people in the community, 50 per 1,000 or something of the kind, whatever the yardstick is, should be admitted; that is what they have to go on.

We will see a cluster of these new homes in the metropolitan area and not in the areas that the honourable member for Paterson (Mr O'Keefe) and I represent. That is the important thing. We come from the coast of New South Wales. I am sure that both of us have some feelings in common so far as the Nelson Bay area of the Lyne electorate is concerned. We have talked about this jointly. The local people are raising the money. They are building a hostel, with the assistance of the Commonwealth. They are seeking the money for a nursing home. The thing that we must remember is that people throughout the western areas, the smaller towns, off the farms and in the metropolitan areas want to move from those areas into pleasant surroundings near the beach, near their families, where they have care; they want to move into a nursing home or a hostel. I hope that these cases are not overlooked, because I believe they are very important indeed.

I can recall the efforts of the people in one place in my electorate, Dungog. For years people there have been trying to build a nursing home. They have raised, I would say, approximately $100,000.

Mr Carlton —A very good place.

Mr COWAN —The honourable member for Mackellar certainly knows about Dungog because he received a deputation from the people there. Beside the State hospital are so many acres of land on which they want to build a nursing home. Because there is a conflict between the State and the Commonwealth, because they cannot work it out, they cannot build a home. There might have been instances over the years where deficits or expenses from the nursing home were cast on to the State. I do not know whether that occurs. Surely, with common sense, there must be some way of working out the cost of the operation of a nursing home compared with a hospital, so that taxpayer can be saved money. People in a nursing home can use the laundry, the kitchen and the facilities available. Yet the people from Dungog cannot receive approval, after all their work. They are willing to go ahead. They will administer the scheme, for sure. They will conduct the home. If an advertisement is put in the paper people will apply, certainly. Somebody will say: 'Yes, but the numbers are not there'. I say that many people from the Hunter Valley would go to Dungog. What occurs in that area is a typical example of what occurs in any other metropolitan area of Australia.

These are the practical matters involved. I appeal to the Government. These are not synthetic things that we see in the legislation. I am very concerned about the legislation because it does not tell us very much about the future policy of the Government with regard to nursing homes, hostels or home care. We have not seen the guidelines properly.

Mr Katter —Bush nurse care.

Mr COWAN —The honourable member behind me said: 'Bush nurse care'. The honourable member for Mallee (Mr Fisher) mentioned a while ago the care in his small country town by the district nurse and others at the hospital. The people are being cared for now, but there is room for improvement. The improvement that we want to see has to come from legislation. It should be practical to work. Local people should have a say. Under the legislation an assessment committee is to be formed. I ask: Who will sit upon the assessment committee? Think about our country towns. Who will appoint the members of that committee? The Minister, upon the direction or the recommendation of the Department? Will they be appointed upon the recommendation of the State or the Federal member? I do not know. However, I would be most interested to know who will sit upon the assessment committee in a country town in particular.

Ms Mayer —Bush nursing sisters.

Mr COWAN —Sure. I would be pleased to see them there. There will need to be more members than those. Who is to say that a person is eligible to be admitted to a hostel or a nursing home? I think these are the important questions.

I was a member of a nursing home care committee in my community for many years. We had before us the advice of the nurse involved. We had the advice of a doctor who was probably a member of the committee. We had the advice of the chief executive officer of the hospital who was also possibly a member of the committee. What practical people in the community would be better to assess whether Mrs Jones or Mrs Smith should be admitted into a nursing home? This is the crux of the legislation. People working in the field can see how the good old folk who pioneered Australia are to be cared for. They do not want to be thrown about. I do not think the Minister wants the final say in this matter. Surely to goodness he does not want a pile of papers in front of him every morning of the week from a nursing home committee or from an assessment committee saying that someone is eligible and ought to be permitted to enter a nursing home or hostel. I do not think the Minister wants that. Leave it to the people out in the field who know what is needed from their own personal experience. I trust that the legislation will be practical when it is applied in the field. We look forward to hearing about other matters over the months to come and about the Government's policy with regard to aged care.