Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020

I rise to support this bill, the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 because it makes a straightforward, positive change to Australia’s home-care system. Right now, home-care providers are provided the full amount of their clients’ home-care packages in advance. This means that any unspent funds, which are often substantial, sit on the books of the provider.

Last week, in the wake of the federal budget, I held a roundtable with home-care providers in my electorate to understand their priorities and challenges. And addressing this issue of holding unspent funds was one of their key concerns. I’d like to thank Leanne Christie, Leonie Painter, Nicola Burns, Jane Archibald and Tracey Hooper, who participated in this roundtable. As a former director of a residential aged-care facility, I know how hard so many providers work on behalf of their clients. I can tell you that these women who I spoke to work very hard every day to do their best for the older people in Indi.

I add to the words of the member for Dunkley to say that aged-care providers and aged-care workers right across this nation are the most undervalued people in our society. Only last night, we heard, on ABC’s Q&A, from the ethicist Simon Longstaff, who spoke to this as well. When we speak in this place of highly paid professionals in the corporate world and we think about our aged-care providers, we can only hang our heads in shame, quite frankly.

My discussion last week at the roundtable reinforced the broader point that the issues in the home-care sector are substantial, widespread and urgent. This bill is a good bill, but really it’s a drop in the ocean of the reform that needs to take place in home care.
Let’s just consider the state of the home-care system right now. The government’s latest data from March shows that more than 103,000 Australians are waiting for a home-care package, the same as a city the size of Ballarat. That figure includes 22,000 people waiting for a level 4 package—that is, people who’ve been assessed by the government as needing around $50,000 a year in order to take care of their basic needs. And they’re getting nothing at all. What’s worse, these figures are from March. The government has not yet released data from the June quarter, which will reveal the impact of the pandemic, which has exacerbated these issues even further.

On top of that, these figures are projected to go up enormously by 2024 as our population ages. And, on top of that, we know that more and more people are choosing to stay home rather than go into residential aged care. And aged-care providers are telling me that, because of the negative perception of residential aged care, because of the absolutely devastating findings of the royal commission and because of the pandemic, people are scared and increasingly trying to stay at home. So the demand for home-based care is rising significantly. We need to be adding thousands of packages every year just to stay afloat, and we need to add vastly more than that if we are to work through the backlog of people waiting for packages.

The current waiting time for a home-care package is over 12 months. I’ve heard from constituents that they’ve been waiting for over two years. Indeed, tragically, some 30,000 Australians have died in the last two years while waiting for the care they need. Before the budget, the Council on the Ageing called for 60,000 additional care packages to be released in the October budget. But what did the budget deliver? Just over a third of that. Twenty three thousand home-care packages is woefully inadequate for the problem that we face.

It’s also fiscally reckless. We know from studies undertaken very recently from Victoria University that investing in jobs in aged care or, for that matter, child care—the full spectrum of caring—would lead to a dramatic multiplier effect in our economy and have a huge effect on GDP.

But, while it is fiscally reckless because of this, the whole point of the home-care system is to ensure people can stay in their homes as they age. When people don’t get the support they need to stay at home, the alternative is that they move into residential aged care, which, on a per resident basis, is four times more expensive for the government than even the most expensive home-care package. So, from an economic perspective, it simply doesn’t add up.

Yet 50,000 Australians are in residential aged care because they couldn’t get the support they needed at home. These are people who wanted to stay home—50,000! The failure to stump up enough home-care packages and fix the other blockages in the system is not only heartless and cruel, it actually ends up costing the government more. So it really doesn’t make any sense to me.

The home-care sector also called for the budget to signal significant reform in the sector. It’s not just about the lack of packages; there are other bottlenecks that simply adding more packages does not solve. For instance, providers are telling me that there are also significant delays in the assessment of people, largely due to the lack of a trained workforce for aged care assessment teams, particularly in rural and regional Australia—in places like where I live—and it’s even worse in remote areas.

There’s also a fundamental mismatch between the package a person receives and the care they need. For instance, imagine an individual assessed as needing a level 3 package whose health actually improves once they receive that package 12 months after they are assessed. That person, in our current system, can’t go down to a level 2 package, and has no incentive to either because, if their health deteriorates again, they will need to go through the full assessment process before they can be bumped up to a level 3 package. So people hang onto these things even if they don’t actually need them at that point in time.

Imagine if we had a more flexible system that allowed us to move people through. It would save us a lot of money and it would be a much higher quality level of care. Bringing us back to this example: that person would have $34,000 a year for their level 3 package sent to their home-care provider but they’d only be spending, say, $15,000. That means possibly $20,000 a year would sit with their home-care provider doing absolutely nothing. And $20,000 is enough for a whole level 2 package, and then some. But, because of a badly designed system, it sits in an account doing nothing. And because of a badly designed system, whilst 100,000 people languish in the queue, there are substantial amounts of money sitting in the accounts of providers going to waste.

The point is that the problems in the home-care system are not just about a lack of funds; it’s also about a gross misallocation of funds and a total failure, over many years, to fix these gaping issues in the home-care system. Moreover, home-care providers in Indi tell me that the process for actually delivering packages is incredibly confusing for many people and causes huge problems for them and for providers alike. When a person gets assessed by an aged-care assessment team they subsequently receive a letter notifying them that they’ve been allocated a package, but being allocated a package does not mean that your package will actually be delivered anytime soon. I think I’ve demonstrated pretty clearly that it certainly doesn’t mean that. When people get this letter it actually means they face a 12-, 18- or possibly 24-month wait to be assigned that package, but they don’t realise that.

The providers I speak to tell me heartbreaking stories of people who call them up excitedly saying they’ve been assigned a package, after which the provider sends somebody out to meet them, only to have to explain to them that they’ll have wait another year or two before anything arrives. That’s not only devastating for the person involved but time-consuming, costly and a very difficult conversation for the provider.

Fast forward a year or two, and that person gets a second letter saying they’ve finally been assigned their home-care package. They then have 28 days to choose a home-care provider. If they don’t do that in 28 days, their package, possibly after they’ve waited years for it, gets cancelled. The providers I speak to tell me there are people who actually don’t understand what this second letter is about, and that many people, after waiting months or years with no support and already having received a letter that really didn’t deliver them anything, simply throw this second letter in the bin and, without knowing, forfeit their right to a package. Clearly that’s a travesty, and it’s not the fault of the vulnerable older Australians who are bamboozled by the labyrinth of the system that we have. It’s the fault of a government that has failed for years to design a system that actually works for the people who need it.

Over recent weeks, in addition to my roundtable with home-care providers, I’ve asked my community what they think of the budget and of the government’s plans for recovery. So far I’ve had 1,200 responses to this survey, and better quality aged care is the second most important issue for people. Just nine per cent of those 1,200 respondents think the government is doing enough on aged care. Eighty-four per cent think it needs to do more. But the numbers don’t say nearly as much as the words do. Here is just a tiny portion of what my constituents told me about the home-care system. These are anonymised, and they are direct quotes.

From respondent No. 14: ‘My mother died waiting for a level 4 package. She was on level 1. My cousin and I had to put her into a nursing home for the last week of her life because my dad couldn’t look after her and we couldn’t access nursing care in the home.’

From respondent No. 112: ‘My mother waited almost two years to receive her package. The money came through when she was 91.’

From respondent No. 142: ‘As a 74-year-old, I find myself visiting more and more of my friends in residential care. Many of them would like to stay at home but, with no live-in care or assistance, it’s simply not possible.’

Respondent No. 128: ‘I had to find an aged-care facility for my dad and his wife earlier this year. They’d both been assessed for a home-care package, but this was going to take at least 12 months to come through, so we just had no option, as they could no longer live at home.’

Finally, from respondent No. 96: ‘My neighbour died of neglect in a system that should have cared for him. He was found unwell by some other neighbours, who took him to hospital, but he was sent home too soon, with not enough home support, and he was left to the care of the neighbours. And then the neighbours found him for the second time, but this time they were too late; he’d died. This man had no family to care for him. He relied on the system, a system that had let him down. And there was no funeral; there were no answers. His body was just taken away, just gone.’

These are not my words; these are the words of everyday Australians who either are themselves trapped in a cruel system or have watched their loved ones die, as the royal commission described, of neglect. I wanted to quote my constituents verbatim today because I want this House to hear, loud and clear, the anguish that so many people feel. So many Australians are crying out for help, and I want this House to hear that cry.

As a former nurse, these stories devastate me but they do not shock me. Anyone who’s seen the system up close knows that it’s broken. Older Australians built so much of the prosperity that we here enjoy. They raised us. They helped build this wonderful country of ours. Yet we condemn so many of them to live out their final years in the indignity and suffering of cruel neglect.

The ongoing crisis in our aged-care system is a blight on this government, and so, while this bill is an important one and a good one and I commend it to the House, I implore the government: hear the voices of my constituents; hear the voices of everyday Australians around our country. We need you to hear them, but we need you to respond.

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