MATTERS OF PUBLIC IMPORTANCE - Economy
12 May 2020
BILLS - Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 - Second Reading
05 March 2020
I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No.1) Bill 2020. As the member for Franklin has pointed out, there are some serious concerns with this. The purpose of the bill is to change the payment of the home care subsidy to approved providers from being paid in advance to being paid in arrears. It will move payments for home care packages to the same model as the NDIS provider payment. This could see increased risks to the financial viability of some service providers, especially for smaller rural and regional service providers who don't have adequate cashflow to deal with payment changes. I know there are lots of concerns in the NDIS sector that payments are often very late. I have one NDIS provider in my electorate who is still waiting on up to $270,000 in payments for invoices issued. Labor will move to have this bill referred to a Senate committee so that these issues can be worked through.
More broadly, as the member for Franklin has moved in her second reading amendment, this government is failing to provide the genuine, wholesale industry reform that the aged-care sector so desperately needs. We have heard from many of the previous speakers that just last week the government was forced to backflip on a plan to privatise the aged-care assessment teams. It was a plan that nobody asked for and nobody wanted. It was the only part of the aged-care system which isn't broken. You have to ask yourself what the motivation was for wanting to privatise it in the first place. There were some serious suggestions that the government saw this as an opportunity to put downward pressure on home care package waiting lists, where we know that some 110,000 people currently sit and are waiting. It was an opportunity, some say, to actually move the assessment guidelines to make some people less eligible for packages or for higher packages et cetera. It would have seen 1,000 workers sacked from the ACAT teams. One thousand workers could have lost their jobs.
The states didn't want this plan. Embarrassingly for the minister, the states and territories pushed back. The New South Wales health minister himself said that it was ill-advised. The unions raised their voices and campaigned against this, knowing that it was bad for the aged-care sector. I want to thank the unions who all worked so hard and campaigned against this. The community spoke out in their thousands about their concerns about seeing ACAT privatised. The royal commission was forced, embarrassingly, into a position to deny that it recommended it, when the government tried to suggest that it did.
Whilst we're on the royal commission, the interim report from the commission was scathing in its criticism of government inaction on aged care, describing the industry as a 'sad and shocking system that diminishes Australia as a nation'. This is a third-term government who constantly throw their hands in the air, seemingly baffled by the problems in aged care and unaware of the countless reports which provide solutions that are sitting still on the minister's desk.
One thing they could do right now is improve transparency and accountability of taxpayers' money. At every opportunity, this government shields dodgy aged-care providers from greater transparency and accountability of what they spend taxpayer funds on. Last year, Labor worked with the Senate crossbench to try to secure changes that would have driven accountability and transparency in the system, a vitally necessary reform. The amendments would have forced providers to publicly confirm how tax dollars are spent—how much money goes to the cost of care, such as food and food supplements, continence aids, staff, mobility aids et cetera. This information is vital for families and residents who are making one of the hardest decisions of their lives, where to entrust the care of their loved ones.
Aged-care facilities receive 70 to 80 per cent of their funding from the taxpayer, yet for so many of them there is very little information on how this money is spent, especially in the for-profit sector. Time and time again in the royal commission hearings we've heard stories from families and loved ones about being kept in the dark, a total lack of transparency and vital information that could give families assurances about the safety and wellbeing of their elderly family members. The interim report of the royal commission makes particular note of the lack of 'fundamental transparency' across the sector. Did the government do anything about this? No. Without accountability and transparency, there is a risk that any new funding will not drive what the community is desperate for—quality care.
Just this week, we heard of yet another aged-care facility failing every industry standard. Tenison residential aged care was found by the Aged Care Quality and Safety Commission to pose 'an immediate and severe risk to the safety' of patients. The facility at Swansea is run by Southern Cross Care (NSW & ACT). It is a not-for-profit provider. Residents there were sleeping on towels and were left in soiled continence pads. The commission reported that the 'care provision did not maintain consumer dignity regarding continence', that there was a serious lack of resources and the 'facility did not have effective systems to respond to abuse and neglect of its residents.' Distressingly, the report said:
There continues to be a reliance on chemical restraint, often in the absence of informed consent.
This facility, as I said, is a not-for-profit facility. It received $1.5 million in government subsidies for 32 aged-care places in 2019. That's $47,000 per resident. We know this, and I know that there are going to be questions asked about the viability of some of our facilities, but we know this because, as a not-for-profit, it does actually present us, the community, with an annual report where it states where its money is spent. But we know that for many, particularly the for-profits, it is not declared so clearly. Without tighter accountability, we can't ensure that providers, especially for-profit providers, will simply not siphon off vital dollars to go elsewhere—the Cayman Islands maybe, or just to excessively line their pockets.
Many aged-care facilities do the right thing—I know that—on both sides, for-profit and the not-for-profit sector. I have great providers in my electorate whom I visit often, and they do their very, very best to provide quality care. I want to give a call out to all of the sector who do the best they can, to the workers who care so beautifully for the elderly with really limited resources. But the government and the people deserve to know where taxpayers' funds are spent.
The government has to get this right and ensure that aged-care funding is adequate to meet the needs of our ageing population and that it is linked to care. The Leader of the Opposition made the very pertinent point that it is in all of our interests to make sure we get this right. That means proper residential care, home care packages and adequate funding for rural and residential aged-care facilities, who are a special case—because of the challenges of remoteness they struggle to stay afloat.
The other key issue this government refuses to tackle is workforce. At a recent hearing at the royal commission focused on workforce, Counsel Assisting Peter Rozen QC slammed the Morrison government's inaction in fixing Australia's broken system, declaring that it's 'time to stop kicking the can down the road'. Counsel assisting made recommendations for the commission to consider for its final report on workforce issues, including minimum staffing numbers, appropriate skill mix, better pay, and better training and conditions for the aged-care workforce. The commission also heard recommendations that would increase the transparency and accountability of aged-care funding, making providers publish staffing numbers and skills mix. Counsel said 'the time is now' for real action, criticising the government for ignoring previous reports and recommendations handed to them as blueprints to fix the workforce issues.
These issues have been the subject of numerous inquiries and recommendations over the last two decades. Peter Rozen QC drew specific attention to John Pollaers's aged-care workforce strategy, which was delivered to the government more than a year ago. In evidence to the royal commission, Professor Pollaers considered the government's inaction in implementing the workforce strategy as 'profoundly disappointing'. The royal commission's interim report said:
Workloads are heavy. Pay and conditions are poor, signalling that working in aged care is not a valued occupation. Innovation is stymied. Education and training are patchy and there is no defined career path for staff. Leadership is lacking. Major change is necessary to deliver the certainty and working environment that staff need to deliver great quality care.
Labor has been saying for a long time that fixing the workforce issues that plague the aged-care system is crucial to delivering quality care in aged-care facilities. In Anthony Albanese's vision statement on ageing, he declared:
Part of the answer to this crisis must lie in our aged care workforce. Those we trust to care for our most vulnerable, our parents, our grandparents, eventually ourselves.
There are too few aged-care workers, and they are paid too little. They have begged the Government to do something.
Labor is listening.
Our aged care workers need proper pay and proper training.
The aged care workforce must also be able to provide culturally and linguistically appropriate care.
Staffing numbers, qualifications, skills mix and experience, all affect the ability of aged care workers to provide safe, quality care.
Under a Labor Government, solving this will be one of the priority tasks for Jobs and Skills Australia.
The impetus to get this right is huge and is something which the wonderful aged-care unions have been raising for years. In order to meet ever-increasing demand for aged-care services and support, the workforce will need to more than triple by 2050. By 2050 we will need to have more than one million Australians working in aged care. This represents a workforce growth rate of about two per cent annually to meet future demand. We must have a quality workforce which sees aged-care workers getting the respect and dignity they deserve.
Aged care is not babysitting. It is not a lifestyle choice. As a nurse, I know that elderly residents have complex health needs, like dementia, that require very specifically well-skilled workers. I want to say a big thank you to all the incredibly hardworking nurses and carers, many of whom must also look after young people in nursing homes. A tragedy of monumental proportions, this was also mentioned by the royal commission. This government has thrown a few dollars into this issue—a bandaid, really—which will go nowhere in addressing the independent housing needs of these young people.
I will never forget the time when former Prime Minister Turnbull said that aged-care workers could always aspire to 'a better job'. I was livid. I leapt to my feet in this place to defend those workers and their unions. Their aspirations are to be able to give better care to the elderly, the people whose lives have been entrusted to them. They hope for better staffing, better resources and better pay, but not one of the people working in that sector has ever come to me and said they want 'a better job'. They love their jobs. They are dedicated. They get intrinsic rewards from ensuring dignity and quality of life. They aspire to make their residents' lives as comfortable and meaningful as possible and they aspire to ensure that their residents have, at the end of their lives, a dignified death. That is the type of aspiration that the then member for Wentworth and his colleagues perhaps did not understand.
I know what funding cuts mean. I know what it's like to be a carer or a nurse and not be able to deliver the care that you want to because there aren't the resources allowing you to do your job, because there's limited access to training and skills acquisition, and because the workloads are impossible. I know what it's like to try to feed four or five patients at once, or to have to decide between doing a wound dressing or taking a resident for a much-needed walk as physiotherapy. It's heartbreaking to have to make those decisions every day.
Finally, last year one of my constituents, Lily Coy, was interviewed by Channel Nine, recounting an experience that hundreds of thousands of older Australians have experienced. She said that she found herself begging for a home care package. She wasn't coping. She couldn't walk from the table to the sink. She was having to demand the assistance she was entitled to—having to beg for the assistance she was entitled to. She said it was humiliating. She said:
We're not bits of paper. We're not numbers on a bit of paper.
Lily said she feels awful thinking about others who are still waiting for home care packages. She said:
It makes me feel so guilty and sad.
The government's announcement this week of 10,000 home care packages means there are still 110,000 older Australians assessed and waiting for theirs. Older Australians and their families remain frustrated, confused and let down by this government, which is so clearly out of touch. It has no idea of what it means to be hoping for help with an older loved one. It has no idea what it means to watch an elderly parent wait in vain for assistance at home. It seems to have no idea or care what it means for a family to struggle to provide that care themselves, juggling rosters at work and juggling care of their own children who need their care and attention. Families take risks, ultimately, because sometimes it just doesn't work out the way you want it to. You worry desperately because you can't get home in time, because an elderly loved one is home all alone for just that bit too long. The crisis is getting worse. It seems the government has no idea what it means to watch an elderly patient wait in vain for help. I'm not going to stand here and tell you the solution is simple. It isn't.
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