Zali Steggall speaks about Improving the standards of our aged-care system

8 September 2022

I rise to speak on the introduction of the Aged Care Amendment (Implementing Care Reform) Bill 2022. This is a bill I welcome following the dire revelations of the royal commission in aged care. I would like first to thank the many who work incredibly hard in this sector. They do their job well, and the revelations of the royal commission would have been incredibly distressing for those in the sector who are endeavouring to give the best of care to loved ones and to our older Australians as they go into residential care.

It's vitally important that this parliament work to improve the standards of our aged-care system. The recommendations of the royal commission were clear—that much-needed improvements to the way we care for our older loved ones must be implemented as a matter of urgency—so I urge the minister to accelerate implementing all the recommendations of the royal commission.

Locally in Warringah, some 15 per cent of residents are now over the age of 65. As Australia's population continues to age, the systems we currently have in place will need to be ready to cope with increasing demand. We must approach the issue with an unwavering compassion and acknowledgement that there are some systemic flaws in the past that weren't acceptable and that need to be changed. Under-resourcing and lack of preparedness have rendered many aged-care facilities ill-equipped to adequately care for their patients and residents, and I think that was made all the harder during COVID, obviously, where additional requirements were imposed upon aged-care centres. We have to remember they are not hospitals; they don't have the level of care that is available in emergency departments, so the balance between the resourcing and where the best care can be provided always needs to be front of mind.

I have spoken with many local residents, nurses and aged-care workers, and they all believe strongly that having registered nurses on duty will absolutely improve the quality of care and reduce the burden on the health system generally. Registered nurses have the skills and training to treat many more incidents and prevent them from happening in the first place. This will reduce the number of residents being taken to hospital, with care able to be provided at the facility, reducing strain on our stretched ambulance and hospital services. The implementing care bill clearly seeks to improve the system, and I urge the government to ensure these measures succeed.

Costings of the bill are not insignificant. We know this is an issue. An accumulated $460 million over the forward estimates is substantial; however, it's an investment absolutely worth applying to appease this shocking crisis. As many have highlighted in this debate so far, it may still not be enough to truly cover the implementation of the measure.

The three schedules in the bill will improve safety and access to care rights as outlined in the Australian Charter of Healthcare Rights. The implementation of a mandated posting of a registered nurse 24/7 in aged-care facilities is a welcome improvement. It's an improvement I strongly advocated during the last parliament, and I spoke in support of the member for Indi's motion in 2021.

I have done some extensive consultation with stakeholders and residents in Warringah. I seek assurance on their behalf that any exemption criteria for schedule 1 will be reasonable and that it will be consistent with the royal commission's recommendations. I echo the concerns of the member for Mayo and in the coalition's second reading amendments about the lack of detail in the primary legislation and the extensive use of delegated legislation. It's critical that the exemption criteria be made known so that we can be assured that reasonable provisions will be in place to protect providers who are unable to obtain a registered nurse. In that sense, I have listened to the contributions of other members of this place in relation to the difficulties in regional and more remote areas. Nevertheless, we also need to ensure that this exemption process is not used by providers to avoid providing better care and having registered nurses.

The department estimates that there is a shortfall of some 850 nurses at present to meet the needs of this bill. We cannot penalise the ratings of these centres for not obtaining staff if they simply doesn't exist. We need to ensure there are exemptions where reasonable steps have been taken to recruit staff but have been prevented by lack of availability amidst the skills shortage crisis. Gaps in individual shifts due to sudden illness or injury of staff and difficulties for employers in abruptly sourcing casual staff should also qualify for a reasonable exemption. The onus should be on the federal government to appease the skills shortage that we are facing and help ensure these exemptions are minimised.

The bill also seeks to cap home-care costs specifically pertaining to service providers no longer charging for cessation of care. I support this in principle as we need to target and prevent unreasonable outlier prices in home care. Some stakeholders in my electorate hold concerns that this schedule will grant the government an unlimited power to regulate all home-care prices. So I call on the government to always be transparent and consultative if they are to implement discretionary regulatory powers.

There are still some issues relating to the crossover between aged care and NDIS. That does not pertain to this bill, but an issue that I would urge the government to address is the gap and the age discrimination that exists in the NDIS system as people then transfer to the aged-care system.

The third schedule seeks to mandate public disclosure pertaining to aged-care services. I support this in principle because we need transparency. But I find it to be broadly written. A general power to disclose information without parliamentary scrutiny could be problematic. So I trust the government will consider reasonable privacy with regard to important information if it's published.

When the royal commission's report was released last year, Australians were collectively horrified to learn of the extent of the real human tragedy in a deeply fractured system. The malpractice and underresourcing were a clear violation of the right to access adequate health care. I'm pleased to see this bill introduced so early on the government's parliamentary agenda. The bill will aim to rectify the three serious gaps in the aged-care industry that were outlined by the royal commission. These are important to fix, but we must remember the commission produced 140 recommendations to fix the system. So we must ensure progress is continual. There is significant pressure to reform the sector ahead of the impending jump in demand. To remain ill prepared for this would be catastrophic. We can't allow this sector to underdeliver quality care.

In consultation with the aged-care workers in my community in Warringah, further fractures have been identified. One aged-care worker I met with identified that there is a significant gap between some aged-care participants receiving access to great support and others who are not. One aged-care worker has alerted me to instances whereby she witnessed dangerously poor hygiene in facilities and in homes and long wait times for support and assistance, even if an emergency button had been pressed. Alarmingly, she had seen staff administering medication to control behaviour and believes that it may have been unethical and unnecessary sedation. We know these were the types of issues that were raised during the royal commission.

Reporting these serious issues through the appropriate channels can prove challenging for some aged-care workers. I note that these complaints are not always acknowledged. So we need to ensure enough streamlined reporting systems are in place so that quality care can be monitored and applied consistently across Australia.

In my community, there are also concerns that some providers have too many people on their books and so they are not resourced enough to provide substantial care for all of them, with fears that a profit-over-people mentality still exists within the sector following the revelations of the royal commission. In particular the concern is for older people without family or close relations or those under public guardianship. They're often left behind with inadequate support. The disparity in quality of care needs to be addressed in those circumstances.

It has to be acknowledged that navigating the aged-care system can be daunting for families and for older Australians. The sector can be quite complex, and many older people rely on family and friends to help guide them through the processes of application, assessment and engagement with service providers. Sadly, people who struggle to navigate the system find themselves being left behind.

As we age, our circumstances can change rapidly. This heightens my concern that underinvestment in My Aged Care has seen waiting lists explode. It can take upwards of 12 months on a waiting list to access home-care packages. In that time one injury, a fall or sudden cognitive decline can see an older Australian completely without access to the level of care they need to stay in their home. I urge the government to eliminate the home-care waitlist, as per the royal commission recommendations, and reform the system to make sure it is sustainable and fit for the ageing population we're dealing with.

Keeping people in their own home longer should be a core goal of the aged-care sector. This is again where we do see age discrimination between the interaction of the NDIS, which finishes at 65, and aged care, which does not provide the same level of support. Again, those without family or community assistance find themselves dangerously undersupported as their needs grow. Without ease of access to adequate supports, older people may be forced into aged-care facilities. This is not of benefit to the government, the economy or the community. For those who live in residential aged-care facilities, care needs to be equitable and consistent. The best way to ensure this is to ensure that we have well-trained, well-resourced staff.

There are profound opportunities to stimulate the economic benefits of a well-functioning aged-care sector. We know this is where the megatrends in employment opportunities are. We know this is where the skill shortages are. The reforms recommended by the royal commission could create around 30,000 additional full-time jobs in aged care by 2030. This excludes the additional 50,000 extra full-time workers that will be needed because of population trends. So now is the time to capitalise on the opportunities afforded by reforming this sector. Of course, we also need to make sure they are properly valued. We cannot expect people to work in these sectors, which we know are so incredibly essential to the ongoing standards we expect in our community, without them being properly remunerated and valued in our society.

This bill brings forward good measures to address three key gaps that were revealed by the royal commission into aged care. It's vital the implementation of these schedules is done thoughtfully and carefully so that meaningful changes can succeed. I again wish to thank those who work so hard to provide quality care within this sector. Their contributions are vital to our older Australians in our communities. It's time we ensure that the unacceptable standards of the past are amended. I look forward to continued action from the government and the minister and to seeing this happen.