Aged Care

25 August 2020

I rise to speak on the issue of urgent aged-care reform. Last week the Prime Minister said in response to questions asked on ABC's News Breakfast that the Commonwealth regulates aged care, but when there is a public health pandemic, then public health is a state matter. These comments are akin to those he made during the bushfire crisis when he told a radio broadcaster, 'I don't hold a hose, mate.' The vulnerability in aged care should have been obvious following the devastating outbreak at Newmarch House. Instead, devastating mistakes were repeated, this time on a massive scale.

The government's handling of the pandemic crisis in aged care has been atrocious. To describe the government's regulation of the aged-care sector as lax is very much an understatement. It has been neglectful. I'm deeply concerned that the government's rejection of Commissioner Tony Pagone's recommendation to establish an aged-care specific national coordinating body may set a precedent for other recommendations that the Royal Commission into Aged Care Quality and Safety will make when it reports next February. Worse yet, I'm worried the government's defensive attitude means we won't even see legislation in response to recommendations before the next election.

Prime Minister Morrison has also said that, on the days the system falls short, he is sorry. The reality is the aged-care system is persistently falling short. It's falling short because of the systemic issues which have beset the sector since the inception of the Aged Care Act 23 years ago. The system was already broken before the pandemic crisis made aged-care failures front-page news. It is why we have a royal commission into the problems plaguing the sector, including chronic underfunding, underskilling and underpayment of staff; the lack of mandatory minimum staffing requirements; no minimum training qualifications; and no transparency over how the over $20 billion of taxpayer money is paid to the sector every year.

The word 'decanting' has also entered our lexicon over the past week. 'Decanting' is a dehumanising term used to describe the transfer of residents to hospital. It is symptomatic of a system that increasingly treats our senior Australians living in aged-care homes as commodities. It is not a system that treats them with the dignity and respect they deserve.

This is not a blanket criticism of aged-care workers. I know many of them wish they could do more for the people in their care, but they are hamstrung by their working conditions and a lack of support or training. Staff in our aged-care homes do incredible work in challenging circumstances, in a system that very much works against them and against those they care for. We owe staff a debt of gratitude. We owe it to them, and especially our senior Australians in aged care, to make these things right. Staff in our aged-care homes aren't paid well, and there aren't enough of them to provide the care that is needed. They're run off their feet because staffing levels are so low that they struggle to perform basic duties, let alone have the time to sit and have a meaningful conversation with a resident to show that they matter and that they are valued.

If we are to deliver excellent relationship-centred care, aged-care workers need to be supported. Quality of care is lacking in Australia's aged-care sector, and it has been lacking for decades. The evidence before the royal commission is clear that there is a link between substandard care and staffing levels. People are coming into residential aged care older and sicker. They are frail and have comorbidities, requiring more care, not less care—and certainly not cut-price care. The type of care required has changed markedly, but unfortunately that has coincided with lower staffing levels and the de-skilling of the aged-care workforce. The result is that the care for our elderly in residential aged care that was once being performed by qualified nurses and physiotherapists is now often being performed by unqualified, unregistered and in a lot of cases untrained personal care workers.

The damning evidence of geriatric medicine expert Professor Kathy Eagar at the royal commission is that some aged-care providers have deliberately reduced their ability to cater for the clinical and health needs of residents in their care by replacing qualified nurses with minimally qualified personal care workers at the very time that the clinical and health needs of residents are increasing. The evidence before the royal commission is that the reduction in the number of healthcare professionals within the residential aged-care area is largely an economic one. The government has allowed this to happen to the detriment of our senior Australians in care. The vital role of nurses, especially registered nurses, has been downplayed and diminished for too long, and this gross error must be corrected. The lack of regulatory control over staffing and training, for which responsibility falls exclusively with the federal government, coupled with a profit model for many operators, has failed elderly Australians and very much needs urgent fixing.

Here is what needs to change, and I quote from Peter Rozen QC:

an approved provider of residential aged care services should have to meet mandatory minimum staffing requirements;

registered nurses, including nurse practitioners, should make up a greater proportion of the care workforce than is presently the case;

all aged care workers should receive better training;

unregulated care workers should be subject to a registration process with a minimum mandatory qualification as an entry requirement;

the care workforce should be better remunerated and should work in safe workplaces;

the organisations for which they work should be better managed and governed, and

the Australian Government should provide practical leadership in relation to all of these things.

The government needs to listen. It needs to act on this advice and not continue to kick the can down the road. Peter Rozen QC also said:

… the time for real action on staffing numbers and mix, skill levels, remuneration, conditions of work, and registration of the unregulated portion of the aged care workforce is now.

The time is well and truly now, and this government needs to act effectively.

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