Dr HAINES (Indi) (16:28): I rise today to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022. It’s heartening that this government is moving quickly on the recommendations arising from the royal commission into aged care. The royal commission’s findings were a wake-up call to the nation. They called for fundamental and systemic reform, but I was frustrated by the pace of reform from the former coalition government. System reform, I understand, is hard, but it doesn’t mean we delay, especially not when so many Australians live in a broken system and in conditions that the royal commission referred to as neglect.
Schedule 1 of the bill will require approved providers of residential aged care and certain kinds of flexible care to have a registered nurse on site and on duty at each residential facility for 24 hours a day, seven days a week, at each facility operated by them. This goes towards implementing recommendation 86 of the royal commission.
A long, long time ago, I was a director of nursing at a bush nursing hospital and aged-care centre. More recently, prior to coming to parliament, I was a volunteer director at a larger aged-care facility. In both places we always had 24/7 registered nurses, and I’m really proud that we did because the quality of the care in those places was greatly enhanced by their presence. We did that because when the bell rings in an aged-care facility in the middle of the night you can’t know if the bell is ringing because a resident is thirsty and can’t reach their water, because a resident has fallen and needs complex assessment of their needs, because a resident needs their pain relief carefully titrated, or because a resident has a woken confused with unstable blood sugars from their diabetes or, indeed, any number of a multitude of significant health needs. The complexity of care and the unpredictable nature of an acute exacerbation require highly trained professional expertise from a registered nurse.
Having worked as a nurse and a midwife across the north-east of Victoria for decades I know how important it is to respond quickly to calls for help. Aged care is frail care. To respond to that care with a registered nurse prevents unnecessary emergency department admissions, it prevents unnecessary transfers of elderly frail people to other locations and it prevents unnecessary distress to their family and their friends. I know that in the daylight hours, as well as the night-time, how important careful clinical assessment, review and planning are for early intervention in things like urinary tract infections and delirium and to provide evidence based dementia care and palliative care. It prevents not only pain, suffering, distress and ED admissions but also GP call-ins, and we know how precious our GP resources are.
It’s unacceptable to leave older Australians in residential care without the highly trained registered nurses that they need. I’ve been calling for the full implementation of the royal commission recommendation since that report was tabled, because the findings on this aspect were particularly woeful. The statistics speak for themselves: one in three people in residential care have experienced substandard care, nearly one in five have experienced assault and one in two have concerns about understaffing and calls going unanswered.
With Australians living longer and having more complex healthcare needs into old age it is becoming increasingly important to deliver registered nursing care in our aged-care centres. Our aged-care population have increasing co-morbidities and chronic disease. Many aspects of daily care of course don’t require a registered nurse—they can be undertaken by well-trained, compassionate personal care attendants—but the round-the-clock supervision of a registered nurse is critical to the quality of that care. Registered nurses provide clinical assessment and decision-making, surveillance, intervention, leadership, education, research and support for personal care attendants, for allied health professionals, for GPs and for families by providing expert and timely advice by bringing together a holistic model of care that caters to the needs of residents in their entirety.
I know that having nurses on site benefits residents, families and staff. I know that it benefits the acute health sector, by avoiding unnecessary admissions. The impacts spread well beyond the front door of the facilities. As I said before, we have an overstretched, overworked and stressed GP workforce. To have 24/7 nurses in our residential aged-care facilities prevents out-of-hours GP calls.
When I talk to providers about this change many of them ask me, ‘Where are we going to find the staff?’ We have a workforce crisis in my electorate and it’s very difficult to fill the vacant spots that already exist, let alone the ones to come. Last night I spoke to an aged-care provider CEO who told me exactly this and recently I visited a small aged-care facility in Alexandra who told me exactly this. ‘We’re running really short on registered nurses,’ they told me. So we need to see more detail from this government about how the legislation will impact small providers in rural, regional and remote locations. I know my colleagues in this House from across rural and regional Australia have similar concerns. My residential aged-care centres already have registered nurses constantly on call, but for many this isn’t just an issue of rostering staff. Our aged-care health workforce is overworked and underpaid, and aged-care centres often don’t roster registered nurses to work into the night; they simply keep them on call. So finding the workforce to fulfil this requirement will not come easy, because of the long-term erosion of the sector and I’m fearful that some small providers simply may not be able to find a registered nurse workforce by the time the requirement comes into force, and this could mean that they have to close. So we need to be really careful about this. We can’t let there be the unintended consequences of small aged-care facilities closing in the regions when there already is a thin market. We don’t want to have a situation where our elderly rural residents have to move to another town for their care, so we need to be pulling out all stops to train and retrain registered nurses in regional areas.
We need to be thinking about things like HECS forgiveness and scholarships. We need to be taking action to support our regional universities. We need to make sure that in rural and regional towns we have the child care available to enable our workforce to train or retrain. And we need to make sure that we have the availability of housing to enable clinical placements—to name but some of the barriers we’re facing in the regions.
The legislation says that there will be exemptions to this requirement, and the Minister for Aged Care is currently consulting with providers, advocates and people in care about exactly when those exemptions will be granted. However, this doesn’t give much peace of mind right now to small providers, who may support the intent of the policy wholeheartedly, as I do, but who simply can’t recruit in time. I would urge the government to act expeditiously to bring these recommendations forward so that we know with certainty in the regions how we’re going to manage this.
I will be supporting the second reading amendment tabled by the member for Farrer, which said:
… notes that, of the aged care providers who do not currently have a registered nurse on site, and on duty, at all times, 53% are based in regional and remote areas and 86% are small providers.
This second reading amendment requires the draft subordinate legislation setting out the exemptions to these requirements to be provided by the government to the parliament so that they can be scrutinised by members and senators. I hope that the minister also sees fit to bring the subordinate legislation setting out the minutes of care part of recommendation 86 to the parliament as well, as this will have a similar effect.
In supporting this amendment I acknowledge the minister’s desire to get this legislation through and to get on with reform. I also note that I don’t want to see rural, regional or remote registered nurses having a second-rate quality of care caused by long, long delays in implementing this change. What I want to see is support to the regions to get these nurses into our aged care. There are some terrific examples of how we’re doing this in Indi, and I specifically want to call out the Alpine Institute, which is run by Alpine Health, a multipurpose service in my electorate. They’ve been growing their own aged-care workforce for some time, but they need investment, particularly in student accommodation so that they can upskill their personal care attendants and division 2 nurses up into division 1.
I want to briefly touch on nurse practitioners. This is the most untapped resource in aged care, and I spoke to Minister Butler about this recently. We need to look carefully at the skill mix more broadly, and we need to be looking at nurse practitioners. The expertise of these highly skilled nurses could completely transform our aged-care sector. I’ve had considerable experience with older persons nurse practitioners and with mental health nurse practitioners. They’re an incredible resource and they could be mobilised across our aged-care sector if policy levers were shifted now to allow them to operate to their full scope of practice. Their access to Medicare items needs addressing urgently, and I brought this to the former government. I want to see action on this, and I call on the government to work closely with the College of Nurse Practitioners to get this happening.
Nurse practitioners get better symptom management in a timely way; they avoid complications; they take pressure away from our public health system; and they, too, take pressure off our overstretched GP workforce. That’s a lost opportunity, but it’s one we could fix. So I really call on the government to get on with this. The other thing that nurse practitioners do, of course, is provide expert medication management, and anyone who’s worked in aged care knows the challenges of polypharmacy with elderly people. Our nurse practitioners are experts with this.
The second schedule will require the secretary to publish information in relation to aged-care services. These services will be specified in subordinate legislation and can include information about how much providers spend on care, nursing, food, maintenance, cleaning, administration and profits. This will allow consumers to make an informed decision. This information is already provided to the department from aged-care services, and it makes sense that it’s also made public so that families and people considering entering aged care can evaluate their options. I have long called for this and a star rating system for aged-care providers, and this data is a crucial building block in creating an honest, transparent system for consumers to learn what applies. This is sensible reform, and I am pleased to support it today.
The third schedule will enable the government to cap the management and administration fees that approved providers can apply to home-care package recipients, and remove the ability of approved providers to charge the care recipient an exit amount. Up to 45 to 50 per cent of the costs of home-care packages go to management and administration fees. There’s no way to tell if the reasonable fees that providers are allowed to charge bear any relationship to the actual costs involved. It’s time these costs were properly regulated. In the area of Hume, which closely mirrors my electorate, there were 2,224 people on home-care packages earlier this year. Ageing at a home is clearly the preference of many of my constituents, so this change will be welcome news to them and their families and will hopefully stop them getting ripped off. They will know that the fees they are paying are going directly to their care, rather than other administrative purposes.
I want to take a moment here to acknowledge the work of the member for Mayo, who has been a dogged advocate on behalf of older Australians. I was honoured to second her private member’s bill, the Aged Care Amendment (Making Aged Care Fees Fairer) Bill 2021, last year. Like the member for Mayo, I’m concerned that a lot of the details of this reform will be set out in subordinate legislation, which does not allow us as a parliament to scrutinise whether they go far enough to prevent the risk of cost shifting and gold plating of other services and equipment charges. I will be pleased to support her amendments when the time comes.
There is still so much to be fixed within the home-care package system. The wait still gets longer and longer, tens of thousands of people long. In north-east Victoria the number of people on the waiting list is getting larger, not smaller, and that’s unacceptable. I call on the government to commit to meeting that standard too, set by the royal commission. Immediately deliver home-care packages for all who need them and cap waiting times for home-care packages at one month.
In conclusion, right now, all around the nation, aged-care workers are providing care to older Australians, whether that be home-based care or residential aged care. When we go to sleep at night, aged-care workers will be continuing that care, and when we wake up in the morning they’ll be there still, and I thank them.