Establishment of the Aged Care Quality and Safety Commission

October 17, 2018

Establishment of the Aged Care Quality and Safety Commission

We support the establishment of a new single point of contact for aged-care consumers and providers of aged care that is focused on quality. The bringing together of the Aged Care Quality Agency and the Aged Care Complaints Commission functions was one of 10 recommendations from the Carnell-Paterson review. You have to wonder why it took so long for this one to be implemented.

The new commission's job is going to be about restoring confidence of aged-care consumers in the delivery of aged-care services, given how much public concern there has been in recent times. The new agency is going to look after accreditation, assessment, monitoring of and complaints-handling for aged-care services and Commonwealth funded aged-care services. It is a huge responsibility that it will carry. The aged-care services include all four areas of aged-care services, including residential aged care, home care, flexible care services, the Commonwealth Home Support Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. So this is really looking out for the quality of care for every aspect of our aged-care system right across the country.

Normally these bills would be considered non-controversial—and in themselves they are—but aged care has become one of the crisis points for our community. In fact, I think my conclusion is that these bills are a missed opportunity for the government to give the new commissioner stronger arbitrary powers, given the level of public concern in relation to service providers. It's also timely that we put the government on notice that there must be no change to the cost-recovery process or the fees charged to ensure that there is ongoing support for smaller providers. The smaller independent providers are part of the mix of aged care in my community. Those and the larger not-for-profit providers are full of staff who are doing what they can within the constraints that they have. They provide the very best quality care that they can, but the constraints they face are enormous.

If we think about the current environment, around 1.3 million Australians are currently receiving some form of aged care, which is provided by around 400,000 nurses and carers. The number of people aged over 85 years is rapidly increasing compared to younger age groups, and it's predicted to double by 2032. It's projected that by 2056 the aged-care workforce will need to have tripled to deliver services for more than 3.5 million people, and older people will represent one in four Australians. That's not happening in isolation. That's happening as the workforce demands also rise for people looking after people with disabilities under the NDIS. Both these things are happening at the same time. In aged care, it's an increase from around 366,000 or up to 400,000 people currently working in the sector to around one million by 2050. That is huge growth by anyone's calculations. Public expenditure on aged care could double as a share of the economy by the 2050s. These are really important financial and social considerations that we have to make.

I want to take a moment to talk about three aged-care workers in my community who have for many years been arguing for workforce issues to be addressed. Nurses and Midwives Association member Jocelyn Hofman, Annette Peters and Shirley Ross-Shuley have been fierce advocates for improvement in aged-care nurse wages and conditions and for quotas, and I support them in that call. They know what they're talking about. They have experienced appalling situations of having to look after too many people, with not enough qualified staff.

I've also heard from HSU members about the pressures they face. Quite frankly, from the stories that have been shared with me by staff and by families of residents, we as a parliament have a lot of work to do to make sure that staff are able to do their jobs as effectively as possible and to spend time with patients so that they feel they are cared for, not just dealt with. That is our greatest challenge.

The role of nurses and personal care workers in the care of our older Australians is critical and will become increasingly important, yet the government has failed to act on any of the issues relating to workers in aged care. And that is despite the urgency of it. It's not like we've got a lot of time to hang around and think this one through in more detail. We've had many inquiries and many reports. We actually know many of the things that need to be done in this sector. It took more than two months for the Minister for Senior Australians and Aged Care to release the report of the Aged Care Workforce Strategy Taskforce, A matter of care, and there has been no commitment to any funding for the strategy. How the government expects to drive reform without committing to or delivering funding is anyone's guess.

Labor has called on the government to immediately implement the workforce strategy and to work with unions and aged-care providers on issues like the proposed 24-hour registered nurse coverage at residential aged-care facilities. Given that the government dumped Labor's $1.5 billion workforce compact and supplement after the 2013 election, we have consistently called for the development of a comprehensive aged-care workforce development strategy to address issues of training, staffing levels and an ageing workforce. The government finally addressed some workforce issues by announcing $1.9 million for an aged-care workforce task force in the 2017-18 budget, but there was not a single representative of the aged-care workforce on the task force when the membership was made public. That gives you some insight into the government's commitment.

There are many other health professionals, such as GPs, occupational therapists, physios and dietitians, who play a key role in the wellbeing of older Australians—those being cared for in the community and those being cared for in residential aged care. In speaking of supporting ageing Australians, I want to mention a wonderful Richmond GP, Dr Ravi, who has coordinated dementia workshops for the community. Along with Windsor GP Dr Rory Webb and a range of geriatricians and careworkers, as well as partners of people suffering dementia, he has offered hope to members of the community who are going through that very difficult situation in their own families or in their own lives. The workshops have also heightened awareness of the gaps that we have in supporting patients and their families, both at a local community level and more widely in the system. I congratulate Dr Ravi on the work that he does. He is a wonderful driver of change within our community.

Of course, some of the support that is needed is about home care. You know how desperate things are in a sector when someone who gets very little sleep because she works full-time in aged care and is also a full-time carer for her mum, who suffers dementia, makes the time to come to a community forum that you're running. When that person gives up the only moment of free time she has, you know that things are pretty dire. When the Medicare task force visited my electorate of Macquarie, focusing on aged care, we had a full house in Katoomba. There were people who'd gone through the process of helping an elderly family member—maybe a mum, maybe a partner—tackle the bureaucracy to get an aged-care home package. The room was full of people, and then on the phone we had input from Anthea Cox-Norman. Anthea is an aged-care nurse. She lives in Hobartville and she shared with us her experience in trying to get the appropriate level of home care for her mum. Anthea works nights and she cares for her mum during the day. I first started speaking with Anthea in March when she rang, concerned that, despite her mum being discharged from hospital in early January into her care, they'd been advised of a nine- to 12-month wait for an in-home care package. Anthea's mum, Flo, has needs that have been assessed as meeting level 4, the highest level of care. I visited Anthea and Flo last month and there was still no sign of her package.

Flo is a character and clearly loves attention, and, as many dementia sufferers do, she calls out constantly and she wants a response and expects a response. She needs constant attention and constant supervision. She can't be left for more than a few minutes alone in her bed. Anthea is doing an amazing job of staying calm in the face of exhaustion, but she's doing it on a level 2 package. Because of her skill, she acts as a second carer for her mum to have showers. She doesn't get respite. The package doesn't give Anthea a break; it just means it's possible to shower her mum a couple of times a week. It is really disgusting to see that people have to cope with this on their own. A day after I met with Anthea, we got news. Flo has been allocated another package, although it isn't the level 4 package she wanted; it is a level 3 package. It is still not going to meet her needs.

Sadly, Anthea is not alone. Kim, from South Windsor, wrote to me recently and said:

My parents are currently waiting...waiting...waiting.

She explained:

... unfortunately, my Mother-in-law never got her assistance and had to be placed in a nursing home instead.

Kim describes the trauma of her mother-in-law having to leave home, having most of her personal effects taken away from her, to go to a single hospital type room. She said that has done untold damage to her mental state and it's really broken her spirit. That's an insight into why it's so important that we support people to stay in their homes. Susan, from Blaxland, told me:

My 89 year old mother was approved for a home care package but there is a 12-month wait ... now we have had to remove her from her home with my dad and put we her into a nursing home ... fancy being separated after 62 years married ...

These people don't deserve this and the government can change it. It is not just sad, it is tragic.

One of the key issues that emerged is that so many people give up on the package that they deserve and the package that they are eligible for; they accept a lower package which provides them with a lower level of care and then they find themselves having to foot the bill for the gap. The cost of that extra care can be a real shock and financially devastating. Those are some of the issues about not just the quality of care but the speed with which care can be delivered to people. The other disappointment for me is the delay in the release of data by the minister. The March data took forever to come out. The latest data was also delayed until earlier in October. It now shows 121,418 people waiting for a package. Fifty-five thousand of them have the highest care needs. It is clear that the government and the minister have failed to curb the growing home-care package waitlist and have done nothing to address the aged-care crisis. It has occurred under their watch and they are responsible.

I have an electorate with many retired and elderly people. In fact, people move to the Blue Mountains and parts of the Hawkesbury to retire and breathe our clean air after busy working lives. It's completely understandable that, as people age, they want to be able to do it in their home, their own space, for as long as they can. We should allow them to do that. What's clear is that the Liberals are just too busy fighting amongst themselves to actually focus on what matters. It doesn't just matter to people in my electorate; it matters to people in everybody's electorate. It's deeply disappointing that dozens of reviews and reports have all been ignored. There have also been the cuts to aged-care funding—billions of dollars from the aged-care system. In the last budget was the illusion that there was more money for home care packages, but that tiny amount was actually coming out of another pot of aged-care money. So let's stop trying to play clever games, and focus on what really matters. It's time the Liberals started doing much better on this critical policy area.

I just want to briefly mention the royal commission—which, obviously, we support, to expose the abuses and the cover-ups. But we can't wait for the royal commission to finish before we start fixing this issue. We've said for a long time that we know the things that can be done, but, with three ministers in five years and billions cut from budgets, the government is just standing still on this issue. We call it a national crisis. We don't do that lightly. We do that because of the contacts we have from people, every single day, asking for help to find out when their package will be delivered, or seeking support in trying to speed up the delivery of that package so that older Australians can be safely, and with quality care, looked after in their own homes.