Failures in Australia's Aged Care System

Failures in Australia's Aged Care System Main Image

21 June 2021

I rise to support the amendment moved by the member for Cooper, noting the systemic, ongoing failures in Australia's aged-care system, as evidenced by the Royal Commission into Aged Care Quality and Safety, including, but not limited to, the use of restrictive practices and restraints in aged care; the inadequacy of the government's response to the Royal Commission into Aged Care Quality and Safety, including delayed and diminished legislative action on key issues and recommendations; and the government's failures in protecting aged-care residents and workers due to their poor management of COVID-19 outbreaks in residential aged care.

Labor supports the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, but the truth is that this government has neglected older Australians, and the aged-care system meant to support them, for eight long years. The reality is that this Prime Minister doesn't want to take responsibility for a problem largely of his own making—from cuts he made as Treasurer. Remember this is the Prime Minister who failed to listen to Australians living in residential aged care and their concerned families, who failed to listen to workers traumatised by systemic failures, who failed to listen to 22 expert reports and who only announced the royal commission just before an ABC Four Corners investigation, which used hidden cameras to reveal abuse and harm to older Australians in aged care, was screened.

The government's response to the royal commission and the crisis in aged care is just not good enough. They've dodged, delayed or outright rejected key recommendations. Nothing will change without reforms to the workforce. There was nothing to improve wages for overstretched, undervalued aged-care workers. The government is failing to collaborate with employee organisations, despite the royal commission's recommendation to do so. At the same time, they're gifting $3.2 billion to providers, with no conditions to make sure this goes to actual care or better food, not just improving their bottom line.

In the time I have today, I'd like to turn to schedule 1, an amendment to the Aged Care Act and the Aged Care Quality and Safety Commission Act to further strengthen legislation on the use of restrictive practices, including chemical restraint. Some of the most alarming evidence to the royal commission related to the widespread sedation or chemical restraint of aged-care residents, often with dementia. Evidence from Associate Professor Juanita Breen from Wicking Dementia Research and Education Centre at the University of Tasmania, in a study of 11,500 residents in 139 aged-care homes, found that 22 per cent of aged-care residents were taking antipsychotics, 41 per cent were taking antidepressants and 22 per cent were taking benzodiazepines on a regular basis, largely daily. As a pharmacist who worked in mental health and psychogeriatrics, and having lost my father to younger-onset Alzheimer's dementia, this is of concern to me and to countless individuals and families across Australia.

The royal commission's interim report titled Neglect found that the use of antipsychotics was not clearly justified in 90 per cent of cases in which they were prescribed and that polypharmacy and chemical restraint have been the norm. Sadly, this robs people of time, like the case of a beloved wife who spent the last month of her husband's life trying to wean him off drugs, who felt the sedating effects of these drugs robbed her of precious time with her husband. As the PSA's Medicine safety: aged care report found, more than 95 per cent of aged-care residents had at least one problem with their medicines, and most had three, including dangerous drug interactions and overdosing; 50 per cent of people with dementia were taking medicines with anticholinergic properties, which can worsen symptoms such as confusion; and one-fifth were on antipsychotics, with more than half using the medicine for too long.

In the final three months of 2019-20, residential aged-care services made 24,681 reports of intent to restrain. As Associate Professor Chris Freeman said, 'Inappropriate chemical restraint and polypharmacy leading to sedation, falls and avoidable hospitalisation are some of the biggest problems in aged care.' Yet the government has failed to act properly, leaving vulnerable older Australians at risk. On this I'll finish with the words of Dr Andrew Stafford, an aged-care and dementia specialist pharmacist and academic at Curtin University. He said: 'While welcoming the budget measures, it doesn't go far enough to reduce the risk of preventable medicines related harm for people living in residential care, particularly those with dementia.'

In the time I have left I'd like to share the experiences of some local people in my community. In a community where one in five people are aged over 65, aged care is something that matters. It matters to everybody, like Frank who writes to me: 'Every baby boomer we know dreads the thought of having to go into a nursing home. Just look back at the issues uncovered by the royal commission and, more recently, the shocking handling of infection control with COVID-19.' He goes on: 'We have all had experience with parents and relatives experiencing substandard care in nursing homes, so absolutely everyone plans to stay home as long as possible. Of course, this means that the current problems with privately owned nursing homes will only continue to worsen as we all age.' He says: 'What all this is leading to is that it seems to me that ageing at home with support is the best and most logical solution. It's the option we plan to take, if we can.' As of December 2020 there were 1,057 people living on the Central Coast waiting for a home-care package. Across Australia there were some 97,000 people waiting for a package, and I'm aware of people who've been waiting for 18 months for a home-care package. The government has announced 40,000 additional packages this financial year and the next, and this is of course welcome. But it won't clear the waiting list while more people join the end of the queue. Older Australians shouldn't have to wait for the care they so desperately need, leaving them and their loved ones at risk and vulnerable.

I'm often contacted by people at the end of their tether waiting for packages for themselves or loved ones. Dianne of Tumbi Umbi wrote to me: 'I've been waiting quite a few months now. I've been granted a level 3 package and in the interim I've been granted a level 2 package, but I've not received either. My husband has deteriorated immensely over the last couple of months, and I'm needing further help as I am slowly going crazy. At present I receive three hours a week.' Jennifer of Long Jetty told me she's the carer of her 94-year-old mother. She's 68 herself, and her mum's on a level 1 package. She's been waiting since February to be upgraded, and Jennifer is concerned that the level 1 package will not give her mother enough support while she herself is in hospital having surgery. Roger, who is 84, was assessed for a level 3 package 18 months ago, which he has not received. He's been paying for the services he needs out of his own pocket and now has a debt to his provider. Carol, who is 82, applied for a package in late 2019 and was assessed the following year. She was assessed at a level 2 package but was told there'd be a nine- to 12-month wait. In May of this year she was advised that she was still looking at a nine- to 12-month wait. Then there's Margaret, 77, of Wyoming. Margaret and her husband were assessed for a level 2 package 18 months to two years ago and haven't had any service since then. Older Australians and those who love them deserve better. The government has to do more. It's urgent and they have to act now.