Labor Senators support the Bill’s aim to increase financial transparency and accountability in the aged care sector. They also note that the Royal Commission into Aged Care Quality and Safety (the Royal Commission) found that:
A lack of transparency and accountability is a pervasive feature of the current aged care system. The consequences for the quality and safety of care have been profound. The age care system needs to be far more open to feedback on its own performance and more accountable to older people receiving care and the community more generally.
Labor Senators believe that the Government’s response to the Royal Commission falls well short of meeting many of the recommendations the Royal Commission sets out, in its Final Report, regarding transparency and accountability in the aged care sector.
Labor Senators also believe that the Government’s entire response to the Royal Commission’s Final Report, not just those sections relating to transparency and accountability, falls well short of solving a number of key issues within the aged care sector. They also believe that the Government’s response fails to deliver enduring long term improvements and reforms to the sector.
Notably Labor Senators believe that the Government’s response to the Royal Commission:
Fails to deliver meaningful recognition and support for the workforce. It did not contain anything to improve the wages for overstretched, undervalued aged care workers. We know that many of the issues in the aged care sector will not be fixed without reform to the workforce.
Fails to clear the Home Care Package waitlist of 100 000. The Government have promised 80 000 packages over the next two years while thousands of older Australians continue to join the waitlist.
Ignores the recommendation to require a nurse to be on duty 24 hours a day, 7 days a week, in residential aged care homes. This is a measure core to improving clinical care for frail Australians.
Fails to deliver the full recommendation of 215 mandatory care minutes per aged care resident per day.
Fails to implement appropriate checks, balances and transparency measures around the use of public funding. This includes ensuring the $3.2 billion commitment to increasing the Basic Daily Fee actually goes to improving care and nutritional outcomes for aged care residents.
Labor Senators note that one of their major concerns with the Government response to the Royal Commission is the number of recommendations which the Government claims to be accepting but doesn’t actually intend on fully implementing. This includes Royal Commission recommendations or sections of recommendations that directly relate to transparency and accountability.
For example Recommendation 112: Immediate changes to the Basic Daily Fee of the Aged Care Royal Commission recommended an immediate increase to the Basic Daily Fee of $10 per resident per day as a Government supplement paid directly to aged care providers. This increase was intended to immediately lift the quality of food and the meeting of basic needs in residential aged care. The Royal Commission found that two thirds of aged care residents are either malnourished or at risk of malnourishment.
The Royal Commission’s recommendation included strict accountability measures including public reporting from an aged care provider of the 'adequacy of the goods and services it has provided to meet the basic living needs of residents, and in particular their nutritional requirements' that includes:
i. details of the provider’s expenditure to meet the basic needs of residents, especially their nutritional needs, and will include spending on raw food, pre-processed food, bought-in food, kitchen staff (costs and hours), and the average number of residents
ii. changes in expenditure compared with the preceding financial year
iii. the number of residents who have experienced unplanned weight loss or incidents of dehydration.
The Government has claimed to have accepted this recommendation – at a cost of $3.2 billion – but rather than include the reporting requirements laid out by the Royal Commission their response simply says:
… the supplement will be payable once the residential aged care provider has given an undertaking that they will report to Government on expenditure on food on a quarterly basis.
Labor Senators are concerned that these funds will end up as a gift for providers to be spent on whatever they please because the reporting requirements the Government requires are not strong enough to ensure this money is spent on food and meeting the basic needs of residents.
Recommendation 112 is not the only example of a transparency and accountability measure recommended by the Royal Commission not to be included in the Government’s response. Recommendation 136: Tools for enforcing the prudential standards and guidelines and financial reporting obligations of providers clearly sets out powers the Prudential Regulator should be provided to deal with aged care providers that do not comply with new prudential standards or financial reporting requirements. While the Government accepts this recommendation it does not commit to providing the Prudential Regulator with these powers, instead stating:
The Government is committed to developing and maintaining a strong, independent Prudential Regulator with sufficient legislative backing, including tools for enforcing standards.
As such, Labor Senators do not agree with paragraph 2.44 of the committee's majority report which states:
The committee is satisfied that the changes proposed in the Australian Government’s aged care reform plan will provide the transparency and quality of care reporting sought by aged care recipients, their families, advocates and the community more broadly, without requiring the current bill.
Labor Senators note that the current Morrison Federal Government are the same Government who have overseen the 'lack of transparency and accountability' in the aged care sector of which the 'consequences for the quality and safety of care have been profound'.
Senator Nita Green
Senator Helen Polley