08 September 2022

Aged Care Amendment (Implementing Care Reform) Bill 2022

Ms WELLS (Lilley—Minister for Aged Care and Minister for Sport) (12:09): I present a supplementary explanatory memorandum to the Aged Care Amendment (Implementing Care Reform) Bill 2022 and move the government amendment as circulated:

Schedule 1, item 2, page 3 (line 26) to page 4 (line 6), omit subsection 54-1A(4), substitute:

(4) Without limiting subsection (3), the Quality of Care Principles made for the purposes of that subsection must:

(a) provide for the circumstances in which an exemption from this section may be granted (on application or otherwise) to an approved provider in relation to a residential facility, including that:

(i) such an exemption may be granted by the Secretary; and

(ii) before granting such an exemption, the Secretary must be satisfied that the provider has taken reasonable steps to ensure that the clinical care needs of the care recipients in the facility will be met during the period for which the exemption is in force; and

(b) provide that such an exemption that is granted to an approved provider in relation to a residential facility must not be in force for more than 12 months; and

(c) provide that more than one such exemption may be granted to an approved provider in relation to a residential facility; and

(d) provide for the conditions that may apply to such an exemption that is granted to an approved provider in relation to a residential facility.

(5) If an exemption from this section is granted to an approved provider in relation to a residential facility, the Secretary must make publicly available information about the exemption, including:

(a) the name of the provider and the facility; and

(b) the period for which the exemption is in force; and

(c) any conditions that apply to the exemption; and

(d) any other information of a kind specified in the Quality of Care Principles.

Before I speak directly to that amendment, I'd like once again to acknowledge and thank everybody who has contributed either to the Senate inquiry or to the ongoing consultation around the delegated legislation. One thing that has been extremely clear to me throughout this process is that we all have a very clear shared goal—to see older Australians get the care that they deserve from the aged-care sector. There is clear support for the intent of this bill.

The government is progressing amendments to the bill because of feedback received during the Senate Community Affairs Legislation Committee inquiry and their subsequent report. I would like to specifically thank Senator David Pocock and his office for their productive and early engagement on these changes, as well as all of the members and senators that have engaged with me and my team on this. I'm open to working with anyone who wants to see improved outcomes for our aged-care sector.

The amendments will clarify points in schedule 1 of the bill. They specifically relate to exemptions that may be granted to approved providers in relation to the 24/7 registered nurse requirements. The amendments provide that the secretary will be the decision-maker in respect of any exemption and that the secretary must be satisfied that the provider has taken reasonable steps to ensure that the clinical care needs of the care recipients in the facility will be met if that exemption is granted. This will ensure that the needs of the care recipients are central to any decision to grant an exemption. The amendments also provide that an exemption cannot be granted for longer than 12 months, ensuring that exemptions are regularly being reviewed. Finally, the amendments provide that the secretary must publish details in relation to any exemptions that are granted. These decisions should be public, as this will incentivise providers to meet that requirement rather than seeking an exemption. It will also increase transparency, providing older people and their families with information so that they can make more informed decisions about their care.

We are committed to getting aged-care reforms right to deliver the care that older Australians deserve, and we will continue to work through the details with the sector, with unions, with older Australians and with our colleagues in this place. We continue to be very open to having discussions and working with other members of this parliament to work towards better outcomes for older Australians. We want to do this reform once and we want to do it well for a lasting positive impact on people's lives. That will require all of us to work together to make it happen.

Question agreed to.

Bill, as amended, agreed to.

Ms WELLS (Lilley—Minister for Aged Care and Minister for Sport) (11:30): The Albanese Labor government is taking a different approach to governing to the previous government. We are not afraid to tackle the big challenges facing our country and we are not afraid to do it at the earliest possible opportunity. And we're not afraid to consult or to reach across the aisle and work with our parliamentary colleagues, regardless of political stripe, to face those challenges. Even if sometimes we disagree on how to do it or how fast to do it, I think it's fair to say that everybody in this parliament wants to see a better future for older Australians and for the aged-care sector.

I want to thank all members for their contributions to the debate on the Aged Care Amendment (Implementing Care Reform) Bill 2022, all of which have been thoughtful and many of which have been based on their or their loved ones' lived experience with aged care. I'd also like to acknowledge and thank everybody who has contributed either to the Senate inquiry or to the ongoing consultation around the delegated legislation. I want to reassure those who have taken the time to participate in these processes so far: we have heard you and the issues you have raised, and we are moving government amendments to this bill today as a result of your contributions to this consultation.

The royal commission told us that we need to do better, and this bill is our earliest opportunity to take steps on that journey. The bill makes important practical changes to the delivery of aged-care services and it provides greater oversight of what funds are being used for. Importantly, this bill also introduces limits on amounts that can be spent on administration costs as opposed to direct care. These measures put the safety of older Australians and the quality of their care first.

The bill introduces a new responsibility for approved providers of residential aged care and of specified kinds of flexible care to have a registered nurse on site and on duty at every residential facility 24 hours a day, seven days a week, from 1 July 2023. This will save thousands of unnecessary trips to hospital emergency departments and will ensure that older Australians living in residential aged care have access to the nursing care that they deserve. From 1 January 2023, the bill also introduces powers to enable the government to cap administration and management charges for older Australians receiving a home-care package and removes the ability to charge care recipients for ceasing care. This will maximise funding that is available to address care needs.

There is currently little transparency in how providers set their prices for care and package management, and there is no cap on how much they can charge. The royal commission heard that some providers were charging up to 50 per cent of home-care package funding for administration and management. I know I have heard that in my electorate and I know that the member for Mayo has heard that in her electorate, and it's something that we seek to address as soon as possible. This bill will provide the means to ensure that high levels of administration and management charges are reduced and that money instead goes directly to meeting care needs.

Lastly, this bill will include amendments relating to the transparency of providers' financial information and other valuable information about providers' operations to empower older Australians to make more informed choices about their care and to shine a light on providers not doing the right thing.

I'd like to take a moment to acknowledge and respond to some of the feedback that we have received regarding this bill. During the Senate inquiry process, some concerns have been raised regarding regional and rural aged-care homes and the impact that the new nursing requirement will have on their ability to operate. We are aware of the issues facing these facilities, and this is exactly the reason why there will be sensible and limited exemptions available while we move to this new 24/7 nursing standard. These exemptions will be designed in consultation with these providers and other stakeholders to ensure that we get them right. It is also why, under the new AN-ACC funding model, which will start on 1 October, remote and very remote facilities are forecast to receive, on average, approximately $290 per bed per day, which is $83 more than the average funding for the current ACFI system.

Some people have also raised the question of how the 24/7 nurse standard will be enforced and whether there will be consequences for those without an exemption. As with any situation where an aged-care provider fails to meet their responsibilities around care standards, the Aged Care Quality and Safety Commission can undertake regulatory responses that include education, monitoring provider performance, directing a provider to take specific action and enforcement action such as sanctions. Ensuring best practice and the safety of older Australians is a priority for the Albanese Labor government.

We also acknowledge comments raised during the Senate inquiry process around ensuring appropriate levels of consultation for the delegated legislation. We agree there should be consultation around the detail, and there will be. On top of hours and hours of royal commission hearings that formed the basis of its important recommendations that this bill will help address, consultation on the delegated legislation is continuing and will be undertaken to determine policy parameters and, where timing permits, on exposure drafts of the proposed delegated legislation. Specifically, the delegated legislation for the exemptions to 24/7 nurses will go through an exposure draft process. I'd also note that all amendments to delegated legislation will be subjected to disallowance and therefore continue to be subject to parliamentary scrutiny.

Before I finish I want to acknowledge the proposed amendment by the member for Mayo. We do not support the amendment to the bill. We are concerned that there is a real lack of certainty about what a schedule of reasonable charges would look like and the responsibility that such a schedule would place on approved providers. I'll hop into that in a moment. However, I really do appreciate the intent of the amendment.

The government will not tolerate providers cost-shifting when we can cut administration and management fees. The bill already allows us to manage charges if unscrupulous providers try to get around the new caps. We will be watching this closely and we will respond and identify those providers who are doing the wrong thing.

Setting reasonable fees for aged-care services is not straightforward. If we set the fees too high, providers that can deliver effectively at lower prices will get a benefit at a cost to taxpayers. If we set them too low, providers who cannot deliver for the national price—for example, a small provider delivering personal care in a rural area—might just stop offering that service altogether. The cost of providing services isn't the same across the country or for all providers, and the last thing that we want for providers in rural and remote areas already struggling is to stop offering critical personal-care services to people in the community because we have legislated a charge that does not meet the real cost of providing that service.

However, I thank the member for Mayo for her engagement on the bill and for her longstanding dedication to better aged-care policy and real outcomes for older Australians in need of care. I look forward to working with her and all my colleagues to deliver better outcomes for older Australians in sessions to come. I thank all members for their contribution to the debate on this bill, and I commend the bill to the House.