When the Royal Commission in Aged Care Quality and Safety was released in 2021, it was a moment of reckoning for this country. It was the culmination of what I have described as a slow collapse – one that occurred over decades – of the aged care system in Australia. It was a collapse overseen by Commonwealth Governments of all political stripes.
The Royal Commission found the aged care system was in such dire need of renewal that an entirely new aged care act was required – the current system could not be salvaged. It is the policy-making equivalent of knocking the house down and starting again.
At the time the Royal Commission was released, I supported all 148 recommendations and called on the Government to respond with action and funding, and not just words. This Bill is an important step forward in responding to these recommendations.
In assessing this Bill before us, I am guided by the same values and principles that always guide my work as the Independent Member for Indi.
Will this Bill improve the lives of people in north-east Victoria, and right across Australia? Will it help older Australians age with dignity and empower them to enjoy all the richness of their later years.
And I know, for people in Indi, where we have a much higher proportion of older people compared to the national average, and where many people move to our beautiful towns to retire, this reform is crucial to their quality of life.
I also ask whether this Bill will assist aged care providers. This Bill is about putting older people at the centre of our aged care system, not providers. But it’s important to remember that aged care workers – the nurses, the carers, the cooks, the cleaners, the admin staff – are essential. For many of these people, working in aged care isn’t just a job, it’s a vocation worthy of dedication. I remember being the matron of the Chiltern Bush Nursing Hospital and pulling my clothes over my pyjamas at 2 in the morning to make sure one of our older residents received the care they needed. I cared deeply about my patients – I know people working in aged care do too and they want to see a system that delivers the best care possible for their residents.
I want to thank those who provide these services in Indi, including Kellock Lodge in Alexandra, the Rural City of Wangaratta and Westmont in Wodonga, and all those who spoke to me about what the Bill before us means to them.
It is important that our aged care system is sustainable, now and well into the future. Australia is ageing. By 2026, more than 22 percent of Australians will be aged over 65, almost triple the 8 percent at the start of the 1970s. As our country ages, more people will enter the aged care system –we need to set it up for long-term success. And that is a task that cannot wait for future years and future parliaments – it is a challenge we must tackle now.
So, in analysing this Bill, with more than 1000 pages of legislation and explanatory material, I have been guided by four key questions:
- Will it put the sector on a sustainable footing as our population continues to age?
- Will it provide regional Australians with equitable access to quality aged care?
- Will it enable more Australians to access home care without harmful delays?
The Aged Care Bill 2024 implements the first recommendation of the Royal Commission – to create a new Aged Care Act built upon a rights-centred approach to aged care services.
This Bill impacts almost all aspects of the aged care system. This includes changes to how at-home care and residential care are funded and establishes a new single-assessment pathway for all aged care services. It creates new powers of oversight and enforcement for the aged care regulator, and a new statement of rights for older persons will underpin the sector. I will address each of these.
One of the biggest changes introduced in the Bill is to change the way people contribute to the costs of aged care – both residential and at home. While the Government will continue to fully fund clinical services – like nursing care, allied health and other therapeutic services, a revamped means-testing process will ensure that those who are able to, will contribute more to non-clinical costs, like personal care such as showering and everyday living like food or gardening costs. The Government has made it clear that lifetime contributions will be capped at $130,000 and how much you contribute will also be means tested.
For those currently in the aged care system – whether at home or residential care – the Government’s ‘no worse-off principle’ is one we must hold them to. This means that no one currently in the aged care system will see their contributions change – the new system will only apply to new entrants. When an older person currently receiving at-home support moves into residential care, they will be able keep their existing contribution arrangements or opt to move to the new arrangements.
However, for new entrants, I hear concerns about this difference in contributions for clinical and personal care. I query, for example, whether a person should have to contribute for showering services, when as someone ages and they need this basic help, it’s absolutely not an optional extra and can in fact be important clinical care.
One of the ways to ensure a sustainable residential aged care system is to ensure it is financially sustainable. The Bill seeks to address this, by putting more money into the system. To be clear, the government will remain the major funder of aged care. But new provisions in the Bill will enable aged care providers to retain up to 2 per cent of the refundable accommodation deposit, or RAD, in residential aged care facilities, each year – for up to 5 years.
I cautiously welcome this change, because I know how hard it is for providers in my electorate to balance their books. We know that in the past year almost half of residential aged care facilities were making a loss from accommodation. This included facilities in my electorate. By making changes to the RAD and room prices, we can help ensure providers stay open in our regional centres and rural hamlets.
Capital improvements are incredibly difficult to achieve and I hope this changes that.
However, I will be following the implementation of these changes closely. We must ensure that any increased revenue resulting from these changes will be reinvested into infrastructure and amenities that residents need – not corporate profits.
This Bill also makes changes to the home care system for older people, so that more people can stay at home in their communities for longer. I welcome the Government’s investment of $4.3 billion into home care and will be pushing the Government to ensure people in regional Australia have equitable access to support at home.
There are a few major themes when it comes to the home care system as it currently exists for people in my electorate of Indi. These themes include the waiting times for assessments, the long distances that must be travelled for care, and the workforce shortages to deliver this care.
Across my electorate, whether it be in Mitta Mitta or Murrindindi Shire, I hear from older people who do not receive the full benefit from their existing home care packages because the costs of travel for providers and taxi and other travel costs for the participant, mean their budgets are chewed up too quickly.
I am also concerned, as are people in Indi, that the new support at home packages will not be large enough for regional participants and these issues will be repeated.
This concern was echoed by Dr John Davis, a member of the Government’s Aged Care Council of Elders who lives in Wangaratta in my electorate. He is concerned that there will not be enough funding in packages to cover the reality of the cost of gardening, cooking and cleaning.
We must ensure new support at home participants are going to receive all the care they need, and I am hopeful the Government’s plans to expand the tiers of home care packages from four to eight will help address these specifically regional concerns. These tiers must carefully consider travel costs in particular, and they must truly reflect the time it takes to keep a home clean and keep the garden under control.
Support at Home will be underpinned by a single assessment pathway. Under this new single-assessment model, non-government providers can play a role in assessing new claims for support – not just government assessors. Providers in my electorate tell me that this new system is showing real signs of promise and hope that wait times for assessments will meaningfully reduce.
For too many people in Indi, long wait lists are stopping them from getting the support they need. Even for people who do receive a funded package, workforce shortages and a lack of suitable providers in regional towns mean it can be hard to actually get care.
The Bill will also establish a new independent statutory complaints commissioner and expanded powers for the Aged Care and Quality and Safety Commission. These were key recommendations of the Royal Commission into Aged Care Quality and Safety.
I support these expanded regulatory powers, because unscrupulous providers and workers must be held accountable. We heard such shocking stories of abuse, neglect and violence in during the Royal Commission and in the years since. The Government must do more to protect vulnerable older people. A new complaints commissioner and expanded quality and safety commission, underpinned by a new statement of rights and principles that focus on the safety, health and wellbeing of older people and puts them first, is a good start.
When I spoke to Jim Blundell, a resident of Mansfield in my electorate, he said what he wants from the new aged care system is to be listened to – to be heard. He wants genuine consultation with older persons to be at the heart of the new system. He wants to feel safe to make a complaint when warranted.
However, I share concerns of some older peoples’ advocacy groups that not all rights under the Act will be enforceable by the Quality and Safety Commission and the complaints commissioner. I am also concerned about limited pathways for reviewing any decisions of the complaints commissioner. If an older person does not feel that the response to their complaint is sufficient, they should have fulsome review rights. I urge the Minister to consider any amendments to address this concern.
There are further improvements that the Government should make to this Bill.
I support calls for amendments such as strengthening whistleblower protections, which the Human Rights Law Centre and Transparency International have said are not up to scratch and provide a worse level of protection than employees in the corporate or public sectors. I support their calls for an end to the fragmented, overlapping and inconsistent whistleblowing regime, and the creation of a whistleblower protection authority.
I also support calls for triennial reviews of the Act. It is currently five years but as we know that is a long time in aged care – any unintended consequences should be looked at much sooner.
I will pay close attention to recommendations from the Older Persons Advocacy Network and COTA Australia, and I thank them for meeting with me to discuss this Bill and for their substantial and longstanding work in this area.
I acknowledge that this Bill is part of a broader package of reforms – many of which I hope will benefit communities in north-east Victoria.
While I welcome many aspects of this Bill, I hear from older people and providers alike that it will do little if we cannot address workforce shortages. Regional communities in my electorate know all too well that this is often a significant contributor to the delays in our older people accessing the quality, reliable, affordable aged care they deserve. The Government must do much more to address workforce shortages.
So while this Bill isn’t perfect, it is a significant step towards fixing our aged care system. A significant step towards learning the lessons of the Royal Commission and doing better by our mothers, our fathers, our aunts, our uncles, our brothers, sisters and friends. I look forward to working with the Government more to improve aged care services, especially in regional Australia.
I thank her for the Minister for getting us to this point and I commend the Bill to the House.