Parliament Updates

Zali Steggall MP speaks on the systemic and ongoing failures of Australia's aged care system

2 February, 2021


I rise to speak on the Aged Care Legislation Amendment (Serious Incident Response Scheme and Other Measures) Bill 2020. The main point of the bill is the establishment of the Serious Incident Response Scheme, putting in place a new system of managing reportable assaults and unexplained absences in residential aged care. It will also require providers to manage incidents of abuse and neglect and take responsible steps to prevent incidents. It will require approved providers of residential care and flexible care delivered in a residential aged-care setting to report all serious incidents to the Aged Care Quality and Safety Commission. It will remove the existing exemption for reporting assaults where the alleged perpetrator is a residential aged-care recipient with a cognitive or mental impairment and the victim is another care recipient.

These changes are important reforms to improve the management and transparency of and accountability for serious incidents within the aged-care sector. Unfortunately, through the aged-care royal commission, we have heard numerous cases of neglect and abuse in the aged-care sector, so many cases that the interim report from that royal commission was titled simply Neglect. The neglect, however, goes far beyond the reporting of incidents. It's throughout the system, where funding cuts and reduced staffing ratios continue to weaken the standard of care provided to aged-care residents.

The Serious Incident Response Scheme is necessary, but it is dealing with the symptoms of a neglected system rather than addressing the cause and increasing staffing ratios and the training provided to carers. So, while I welcome the establishment of this scheme and the recognition that the government bears some responsibility for the neglect in aged-care facilities that we too often hear of, I maintain that broader reform of the sector and increased funding is required to address the root cause of these reported incidents of abuse and neglect.

In Warringah, aged care is a key issue. Of the total population, 15.7 per cent are over 65, and this proportion is growing. I've spoken with local providers about this bill and I've engaged with Leading Age Services Australia. Local providers and the LASA agree in principle with the need for the broader incident-reporting scheme but believe the legislation as currently drafted may cause some difficulties as well for the sector. They're concerned that something like a heated argument between two residents about who gets to sit where at dinner would possibly be a reportable incident under the legislation. There's also a concern about the lack of a need for consent from residents for the reporting of incidents, particularly in respect of incidents between residents and family members. While the LASA are working with the regulator and the department on refining these elements, they argue—and I would agree—that these elements should be agreed to and sorted out prior to the parliament passing this legislation.

The proposed commencement schedule is another concern shared by the sector. The new reporting arrangements are due to commence in April this year; however, the aged-care facilities are yet to receive detailed guidance from the department on how they will be implemented and what the requirements are. The bill also introduces a range of new penalties for breaches of incident-reporting and other obligations. In the circumstances, the sector argues that the new penalty regime has come from left field; there wasn't detailed consultation and they've not had the opportunity to discuss the detail with providers. In the broad, the new penalties better reflect appropriate degrees of escalation and the opportunity for review than the current penalties regime, but the new penalties sit alongside existing penalties, which further complicates the regulatory environment for providers. So a broader overhaul of the penalties regime as part of the response to the royal commission findings would be more appropriate.

But there's no doubt that there are broader concerns about the aged-care sector. As we heard during the royal commission into aged care, there are countless stories of neglect throughout this underfunded system, and it requires a broad overhaul. But today we saw further data released from the royal commission showing that 36.9 per cent of nursing-home residents presented to an emergency department at least once in 2018-19. We need more regular reporting of this data and more transparency in the aged-care sector, beyond the context of a royal commission.

A constituent approached me with her own story of her partner's experience with the system, and she would like me to share her story for the record. John was diagnosed with a brain tumour and subsequently suffered a stroke. He required the care of a residential aged-care facility. Following his admission, John endured multiple reviews by his ACAT, the aged-care facility provider and other specialists. John's wife, Paula; My Aged Care; and the aged-care provider disagreed about the level of care required, and they ended up in countless rounds of dispute. The only person that paid a price, ultimately, was John, in the level of care he received. In 2019, John was admitted to hospital, and, upon admission to hospital, his accommodation at the aged-care facility was terminated immediately, with the facility stating they were no longer able to care for him. The termination notice did not offer any alternative care arrangements, and Paula felt isolated by the experience, with no-one to care for John. With nowhere else to go, he spent his final months in two different hospitals, until he passed away.

We need to do better as a parliament—and I'd urge the government to do better—but also as a society. This is not how we should treat the elderly, people who have spent their lives contributing to our society, to our economy and to our welfare. This story of the costly burden of compliance and reviews is uncomfortable. There are so many stories across so many electorates of people where the system is failing them. It is possible that there were reportable incidents in John's case that potentially could have been reported through the Serious Incident Response Scheme. So we need more qualified staff at the aged-care facilities and more consistency of care to improve the standard of living for older Australians. The level of admission to emergency departments for aged-care residents is a concern, and it must be a red flag to the government that there is a lack of sufficient staffing ratios—a lack of registered nurses and the people with the experience and the qualifications to deal with the high level of care needed.

Home care is an issue that comes up a lot. I commend the intent of the government to keep more people out of aged-care facilities and in their own homes. It is something that comes up a lot when I speak to constituents. But to do this we need to be better at delivering the home-care packages that they need to support their independent living arrangements. I've spoken in this place previously of the need to address the urgent needs of 100,000 people waiting for approval of their home-care packages. I regularly receive correspondence from constituents complaining of the difficulties in obtaining an ACAT assessment, and then the long waiting time for the home-care packages. A constituent recently approached me with concerns that her father has been waiting nearly two years for the approval of his level 3 home-care package. It seems that the greater the level of support required the longer you have to wait.

The ultimate cost of this delay far outweighs any savings government realises from not approving the package sooner and delivering it. With the cost and the quality of life for those in need, not to mention the frequent hospital visits and the countless hours of unpaid carer responsibilities taken on by family members taking them away from their usual employment, there is no saving by failing to deliver the high level of home-care packages needed. It's inhumane that, last year, 28,000 Australians died while waiting for their home-care package to be approved. How many of them would have lived longer, more comfortable lives had their package been approved and delivered sooner? The elderly deserve respectful, affordable, accessible and safe aged-care options that are offered in a timely manner. We want aged care that promotes independence and wellbeing, with choices so people can stay at home longer while being healthy and connected, and more options for a suitable mix of home help and medical support.

So, whilst I welcome this bill and the need for the Serious Incident Response Scheme that was recommended by the Australian Law Reform Commission report, and I welcome that this bill is consistent with the findings of the interim report of the royal commission and is recognised by the community, the sector and providers, I urge the government to accelerate its negotiations and communications with providers to finalise the detail of the reportable incidents and the rollout of the required information to affected providers as soon as possible.

I urge the government to look more broadly at the changes they are making—from the penalties alignment to the opportunities presented in this bill to the need for broader reform of the aged-care, home-care and disability support sectors. We need to simplify the system and make it easier for people to understand; improve access to the care that they need; reduce administrative costs; and ensure that the money goes to where it is needed, which is for the care of our elderly.