Chapter 3Views on the bill

3.1The committee received evidence that reflected a range of views on the bill. The majority of submitters recognised the urgency to implement new legislation to reform the aged care system. Inquiry participants acknowledged that the bill marks an important step towards improving Australia’s aged care system and in general expressed support for the bill.[1] However, some witnesses expressed concerns about aspects of the bill’s key provisions.

3.2This chapter explores the key views on the bill that were raised by inquiry participants, including matters related to:

the new funding model for aged care services;

the means-tested user-pays model;

enforcement and protection measures;

the Aged Care Rules;

support for providers during the transition to the new system;

the inclusion of diversity groups in the bill’s provisions;

worker screening; and

access to aged care for young people.

3.3The chapter concludes with the committee’s view and subsequent recommendation.

Sustainable funding of aged care services

3.4The Royal Commission found that aged care funding was insufficient and insecure, which affected access to, and the quality of, care for older Australians.[2]

3.5The Aged Care Taskforce, which was created by the Government to examine funding of aged care, found that care needs are increasing as the population ages and that ‘the aged care sector is currently not in a financial position to meet expected demand, deliver on the required quality improvements or invest to meet Australia’s future aged care needs’.[3]

3.6The Aged Care Taskforce (the Taskforce) found that a new approach to the funding of aged care was required to ensure the sector was financially sound. The Taskforce argued that ‘only a financially sound aged care sector will attract the additional investment required to deliver quality care for older people.’[4]

3.7The bill implements the Government’s response to the Taskforce’s final report, as well as 60 recommendations from the Royal Commission. In regard to funding sustainability, Chapter 4 of the bill implements the recommendations of the Taskforce relating to balancing individual contributions to care and Government funding for care.[5]

3.8Chapter 4 of the bill sets out the arrangements for the funding of aged care services, including both the Commonwealth and individual contributions. The Chapter includes both the Support at Home funding arrangements and funding for residential aged care services. The arrangements in Chapter 4 are based on the report of the Aged Care Taskforce, which included the recommendations:

Recommendation 2: continue the significant role for government funding of aged care services. A specific tax or levy to fund aged care is not recommended.

Recommendation 3: it is appropriate older people make a fair co-contribution to the cost of their aged care based on their means.

Recommendation 4: ensure a strong safety net for low means participants to meet aged care costs.[6]

3.9The provisions in the bill implement the Taskforce’s recommendations by creating the individual fees and contributions aged care services (in home support) and aged care services through residential aged care homes.

3.10The Department of Health and Aged Care (the Department) highlighted that in making changes to co-payments in residential care and in home support there is the ‘important principle that clinical care is free and not subject to any co-payment’.[7]

3.11Organisations and individuals raised a number of issues regarding individual contribution to aged care during the committee’s inquiry. These included:

consideration of an aged care levy as part of Commonwealth funding for aged care services;

provider funding sustainability;

changes to refundable accommodation deposits (RADs); and

funding for workforce sustainability.

3.12These issues are outlined below, with issues specific to means testing in the Support at Home program discussed later in this chapter.

No levy

3.13The Royal Commission suggested the creation of a levy, which they considered would operate in a similar way to the Medicare Levy.[8] The Taskforce considered a levy, as well as other suggestions including an increase to the Goods and Services Tax. Ultimately the Taskforce rejected a levy, noting that ‘[t]here are substantial intergenerational equity issues in asking the working age population, which is becoming proportionally smaller to pay for these services’.[9]

3.14Some submitters were supportive of a levy, including National Seniors Australia, who stated in its submission that while it is committed to a levy, it is concerned that the design process would delay implementation of a new aged care system.[10]

3.15The Australian Council of Social Service (ACOSS) were critical of the Government’s decision not to implement a levy. In its submission, ACOSS noted that it had recommended to the Taskforce the introduction of a 15 per cent levy on superannuation fund earnings after retirement to fund an ‘Aged Care Service Guarantee’. ACOSS stated in its submission that they do not support increasing consumer co-contributions in the aged care system.[11]

3.16The Government has recognised the need for increased funding for aged care, noting in the Hon. Anika Wells MP, Minister for Aged Care and Minister for Sport’s (the Minister) second reading speech that ‘in the next 40 years, the number of Australians aged over 65 is expected to more than double, with those aged over 85 expected to triple.’[12] In its response to the Taskforce’s Final Report, the Government confirmed that it would ‘remain the majority funder of aged care services’ and that it had ‘ruled out a specific tax or levy to fund aged care.’[13]

Provider financial sustainability

3.17The committee heard that sustainable funding for providers of aged care services was critical. For example, Ms Nikki Meredith, CEO of Matthew Flinders Care Services, a residential aged care provider, told the committee:

At the moment we are cake-stalling. We are raising funds. We are approaching community organisations for assistance. We are really trying to promote the urgency of investing in aged care in our region. We can't keep that cake-stall approach to raising funds in aged care. We don’t have the resources, and the community are tired of putting their hand in their pocket.[14]

3.18Several witnesses representing aged care service providers, including residential aged care homes, told the committee that they did not have sufficient funds to invest in facility upgrades or expansion. Ms Melissa Argent, CEO of Rockpool Residential Aged Care told the committee that to build one residential aged care room the cost would be between $400,000 and $500,000 a bed.[15]

3.19In their submission, Boneham Aged Care Services Inc. explained that currently they were unable to plan for refurbishment or expansion of facilities due to their financial situation:

Changes to funding principles over the last 2 years are positively impacting Boneham’s financial sustainability but are yet to demonstrate that they will move Boneham to more than a cost recovery (breakeven) position over the next 12 to 24 months. This means that there is little likelihood of surplus funds for refurbishment or development of new beds to satisfy the current 215 bed shortage in the Limestone Coast region.[16]

3.20Ms Tracey Burton, CEO of Uniting NSW/ACT, told the committee that the aged care sector had struggled to be financially sustainable, affecting services for older Australians. Ms Burton was support of the financial sustainability measures in the bill, telling the committee that these are ‘important not just for the sector itself but so that the services can be available for the people who need it—our older Australians.’[17]

3.21Mrs Stephanie Buckland, CEO of Amana Living, told the committee that the measures included in the bill are ‘moving in the right direction’ for sustainable funding:

What a sustainable funding model looks like to me is one where we're able to run the day-to day operations of caring for people and then generate enough headspace, if you will, and surplus to be able to invest in training, technology and facilities. It's about doing the day-to-day and then having the money and the headspace to continuously improve. I think the provisions that are in the proposed legislation are moving in the right direction to allow us to do that.[18]

3.22However supportive of the new system in the bill, providers were also concerned about the cost of transitioning to the new aged care system. An example of the concerns was Uniting Care Australia’s call in their submission for there to be funding arrangements made to assist providers in the transition.[19] The issues raised around transition to the new system are described later in this chapter.

3.23In response to provider concerns about transitioning to the new aged care system, the Department explained that, in partnership with the Aged Care Quality and Safety Commission, they are developing ‘an integrated readiness plan’ to provide support for both the aged care sector and older Australians. The plan is to be tested with the sector in November and ‘will provide clarity on what is new, what is changing and what is staying the same.’[20]

3.24The Department outlined the resources that will be available to the sector:

Providers can expect resources and guidance materials specific to the changes, booklets (including translated versions), updated guides, practical scenarios, system training (where required), and toolkits to support communication and engagement with their workers. Workers will also be supported with tailored information and guidance.[21]

3.25The Department recognised provider concerns about the potential increased compliance costs of the new system, particularly in the case of regional and rural providers.[22] The Department explained that:

we continue to work through proposed conditions and obligations, with key stakeholder groups, including Multi-Purpose Services Program (MPSP) providers, State and Territory health agencies, and the Aged and Community Care Providers Association, as well as the Remote Accord in terms of impacts on remote providers. Adjustments to regulatory requirements to reflect challenges in thin markets will continue to be considered. Eligible providers will also have access to flexible funding for the provision of funded aged care services under the new Act in thin markets, consistent with the recommendations of the Aged Care Taskforce.[23]

3.26The changes to Refundable Accommodation Deposits (RADs) are one set of measures the bill has taken to increase the funding for providers of aged care. Issues raised by submitters and witnesses regarding the changes to RADs are outlined below.

Refundable Accommodation Deposits (RADs) and retention by providers

3.27The measures in Chapter 4 of the bill regarding Refundable Accommodation Deposit (RADs) add towards the sustainability of funding for aged care services, and particularly towards assisting providers of residential aged care services to make upgrades to their infrastructure.

3.28Evidence provided by the Department outlined the changes to RADs under the bill. The bill allows for an increase the RAD up to $750,000 without the need for providers having to seek an exemption. Of the RAD amount, the rules will provide for providers to retain 2 per cent per annum (deducted monthly) of the amount of the RAD, with a cap of five years on how long the provider is able to contain this part of the RAD.[24]

3.29The Department provided information on the breakdown of RADs and DAPs across the residential care sector. Figure 3.1 below illustrates the percentages of RADs and DAPs from financial year 2018-19 to 2022-23.

Source: Department of Health and Aged Care, Answer to Question on Notice, 3 October 2024.

Breakdown of RADs and DAPs across the residential care sector.

3.30Ms Susan Trainor, Assistant Secretary Funding Operations and Analysis Branch in the Department, explained that the Government intends for the amount of RADs retained by providers to be put towards upgrades to facilities:

There will be no additional conditions associated with the retained amount [of RADs]. Once a provider has retained that, it effectively becomes consolidated revenue, although I believe the government set out in some of the announcement material that the expectation is that it will be going towards capital builds and upgrades.[25]

3.31Regional and remote providers told the committee that the increase to the RADs limits, while good for metropolitan areas, was not necessarily of benefit to regional and remote areas. Mr Trevor Johnson, Chief Executive Officer of the Eyre Peninsula Old Folks Home Inc explained that residents were concerned about the potential for increase in RADs:

One of the comments that I got from some people who heard about the proposed retention of the RADs was: 'Hold it. So I'm not going to have my money? You're going to take my money off me?' When they talk about the $300,000 RAD, they're already concerned about having to pay $300,000, but potentially losing 10 per cent a year of that actually is of concern to some of our residents.[26]

3.32Boneham Aged Care Services Inc., which is based in Millicent, South Australia, explained in their submission that the increase in RADs is of little benefit to them, given their location. Although they were supportive of the new retention amount proposed in the bill:

Whilst this is a significant benefit for metropolitan providers and large regional providers (where housing values are significantly in excess of this amount) it is of lesser benefit in our region (and many others) where the median price of housing remains less than $400,000. The median housing price makes it unaffordable for regional providers to charge a RAD in excess of that price as it is unaffordable for the vast majority of potential residents.[27]

3.33Other witnesses told the committee that they could see benefits to flow from the retention of RADs provided for in the bill. For example, Mr Tom Symondson, CEO of the Aged and Community Care Providers Association told the committee:

For the first time, I can see optimism in people's eyes again. They were a very burnt-out group of people two years ago, who were just thinking: 'There is almost no point continuing. The trajectory is so steeply downwards that we're just never going to be able to rebuild or build new beds.' Now we've got people saying to us: 'We've got three sites,' for example, 'that we have development approval for, that we've had for a couple of years, that we thought we were just going to have to withdraw from. Now, with the retentions from RADs but also, more importantly, the overall viability improvements that the act should deliver, we might be able to build those.' I think we are going to see that it will start as a trickle, because of course the information is not yet fully available, but it will increase in numbers the organisations that are willing to invest again, which we desperately need them to do.[28]

3.34In recognising that RADs are important for provider financial sustainability, the Department explained that there are protections for individuals with lower means, once the measures in the bill increase the maximum RADs. Dr Nick Hartland explained that there are incentives for providers to keep over 40 per cent of supported residents, noting:

There's a higher rate of accommodation supplement that gets paid in those circumstances. Overridingly, supported residents are about 45 per cent of the residential aged-care market, so we think it's very unlikely that, en masse, providers will not want to look at what's nearly half of their potential market…In addition, though, there'll be a review of accommodation payment arrangements, and we'll look to see whether there's anything more to be done to strengthen those provisions.[29]

3.35The Department advised that the Government has announced an accommodation pricing review, noting that the review:

will give further consideration to some of the recommendations of the taskforce that have not been enacted in the immediate response, and that does include consideration of the appropriateness of the MPIR and the current relationship between RADs and DAPs.[30]

3.36Ms Susan Trainor, Assistant Secretary Funding Operations and Analysis Branch told the committee that ‘the government has indicated that the review would occur over the next two years.’[31]

Workforce sustainability

3.37The committee heard that providers in regional areas struggled with retention and recruitment of staff, and a particular challenge was finding accommodation for staff. Ms Michelle Schupelius, Operations Manager at Edenfield Family Care in Port Augusta, told the committee:

Mostly for us, it's retaining staff. Finding staff in Port Augusta is also quite difficult … The other thing that we are concerned about is the ability to house staff. We're having to find accommodation for them, and it is quite difficult in regional areas. There are also concerns about attracting people to a regional area.[32]

3.38Mr Trevor Johnson, CEO of the Eyre Peninsula Old Folks Home Inc., told the committee that staffing was a chief cost, particularly the mandated registered nurse coverage. He explained what implementing this measure had cost his business and how it had meant putting off upgrades to infrastructure:

It's cost us $888,000 net, at least … We were in a relatively lucky position in that, over the years, the board has been careful. They were saving up money to do major refurbishments to the facility. We've now had to use that money to help fund the RN mandate … We don't have any other income sources, and every upgrade we would do would actually enhance the wellbeing of our residents and increase our capacity.[33]

3.39Some submitters highlighted the benefits of the Government’s increase in pay for aged care workers.[34] For example, Mr Christopher Stewart, Chief Executive Officer of Helping Hands Aged Care Inc., told the committee at a hearing in Port Lincoln, South Australia:

We have found that the increase in pay rates has been really welcomed and has had a positive impact on our business. If I look back at 2019, we had a turnover rate of around 20 per cent. That went up to over 35 per cent during COVID and post COVID, when it was obviously very challenging. Now we're back into the low 20s. We think that the ability to both attract and retain staff has been improved through the wage increases. It doesn't take away from the challenges of finding staff in the regions, especially registered nurses. Helping Hands Aged Care.[35]

3.40Similarly, Ms Nikki Meredith, Chief Executive Officer of Matthew Flinders Care Services non-profit aged care provider, agreed that the wage increase had had a positive effect on their workforce. Ms Meredith explained that the publicity around the wage increase and the praise for aged care workers had been beneficial to the workforce.[36]

Means-tested co-contribution to aged care services

3.41Chapter 4 of the bill outlines the divide between Commonwealth support for aged care services and the means-tested co-contributions from users of the services. Information provided in the Department’s overview to Chapter 4 notes that ‘[t]he Bill enables fair co-contributions from those who can afford to contribute to the cost of their care, which are based on recommendations of the Taskforce. The aim of these reforms is to ensure that the aged care system is financially sustainable into the future.’[37]

3.42Government subsidies apply to some aged care services (predominately clinical services) and are divided into two groups: person-centred subsidies are linked to an individual’s eligibility and provider-based subsidies are linked to a registered provider’s characteristics (for example, location or specialisation). The person-centred subsidies include features of the Support at Home care packages.[38]

3.43Individual co-contributions for aged care services, across both residential care and in home support, are set out in Chapter 4 of the bill but with operational detail included in the rules. Means-testing will determine the level of an individual’s co-contribution, based on the individual’s income and the kind of service delivered.[39]

3.44Chapter 4 outlines the division between clinical care (for example nursing, which is funded by the Commonwealth) and everyday living support (for which individual co-contributions are specified). Noting these categories, the bill creates an aged care service list which will prescribe the services available, and the Department has released a draft list for consultation.[40]

3.45The Department has explained that individual co-contributions for home care services will be set as a percentage of the price of each service and that rates will be based on the type of service, noting:

There will be no contribution for services in the Clinical category, with assessed clinical care needs to be fully funded by the Government.

Contributions for services in the Independence category (eg personal care) will be moderate, recognising that many of the services in this group play an important role in keeping people out of hospital and residential aged care.

Everyday living services (eg domestic assistance and gardening) will attract the highest contribution rates, recognising that the Government does not typically fund these services for people at other stages of life.[41]

3.46The Department explained that means testing for co-contributions to residential aged care, including income and asset threshold, will be specified in the rules.[42]

3.47Primarily, evidence submitted to the committee on the user pays co-contributions related to Support at Home packages, including transition of the Commonwealth Home Support Programme (CHSP) to Support at Home, caps for services, and provider concerns. These issues are detailed below.

Support at Home

3.48The Support at Home program introduced in the bill implements recommendation 1 of the Aged Care Taskforce. Support at Home will provide older Australians with care services in their home, according to different levels of care and categories of service.

3.49Mr Michael Lye, Deputy Secretary of Ageing and Aged Care at the Department, explained that the Support at Home program:

… aims to provide improved access to supports and services to help people remain independent at home with higher levels of care in the home so that people can remain home for longer. The bill enables fair contributions for those who can afford to contribute to the cost of their care, which is based on the recommendations of the Aged Care Taskforce. The aim of these reforms is to ensure that the aged care system is financially sustainable into the future as the population ages.[43]

3.50In terms of individual contributions to Support at Home care packages, the Department witnesses outlined for the committee that clinical care will not attract an individual contribution, but ‘for independence and everyday living – and the services included in those two categories are in the service list for Support at Home – people will pay a percentage, depending on their means, for the services that they receive’.[44]

3.51Some elements of the Support at Home packages were raised by witnesses to the committee, including the proposed 52 hour cap on cleaning assistance, transition between levels of care in the Support at Home packages, and the proposed cap on care management at 10 per cent. These are discussed below.

Caps for domestic assistance

3.52Material produced by the Department for consultation on the specifics of the Support at Home packages specifies 52 hours for cleaning assistance and 18 hours for gardening.[45] The Support at Home handbook notes that ‘The annual caps will be in place to ensure funding is available to focus on clinical needs and maintaining independence. The department will monitor the cleaning and gardening cap settings to ensure they remain fit for purpose.’[46]

3.53Providers and advocacy groups raised concerns about cap of hours on domestic assistance for Support in Home packages. Mr Douglass Doherty, CEO of Family Based Care Tasmania, a not-for-profit provider of community supports, told the committee that ‘domestic assistance is currently the service type most utilised by the Commonwealth Home Support Program consumer and the home-care package consumer’.[47]

3.54Mr Doherty noted that ’39 per cent of all care delivered in the Commonwealth Home Support Program by my service is domestic assistance. In the Home Care Packages Program this reduces to 31 per cent, with an average of three hours per week being delivered.’[48]

3.55Mr Jim Paterson, Senior Manager at Advocacy Tasmania, an organisation which provides advocacy and rights education to older people and other vulnerable communities, told the committee that the 52 hours per year cap was too low:

some of the reasoning is that they're thinking these are the types of services people use a lot—cleaning services and domestic assistance—but they're also the things that people need to enable them to stay at home for as long as possible. The cap at 52 hours in a year is very low for cleaning, and, for some people, 18 hours for gardening is also extremely low. And, for some people, when you look at consumer directed care, they might be the two items that they want actually more of, compared to some of the other items they may not need yet in their package, although that they might at a later date.[49]

3.56The Department explained that the caps currently proposed are subject to consultation, and feedback received to date had reflected evidence the committee had heard.[50]

3.57Mr Nick Morgan, Assistant Secretary, explained that the caps were proposed to make sure that people included sufficient budget for all services, ‘avoiding too much of a person’s budget being loaded in to cleaning and gardening services.’[51]

3.58Mr Morgan told the committee that the caps were:

… selected based on really what was seen as a reasonable amount of cleaning and a reasonable amount of gardening. A couple of hours a fortnight of cleaning was seen as meeting a reasonable community expectation of what a cleaning service would provide. An hour and a half a month for gardening, where it might be less in the winter and more in other months, was seen as what would be a reasonable expectation.[52]

Transition between levels in Support at Home program

3.59National Seniors Australia expressed concern that the process for transition between levels of Support at Home care is unclear. Further, they explained in their submission that the wording in the bill implies that a fee could be charged for a reassessment of the level of support. National Seniors Australia were concerned that this would deter people from applying for increased support as their needs changed.[53]

3.60Clause 64 of the bill provides for aged care reassessments. The Explanatory Memorandum notes:

Clause 64 provides a process for individuals who are already approved for funded aged care services to apply for a reassessment of their need for services. In practice, this is expected to be done by an individual or their supporter contacting My Aged Care. There will be two types of reassessments – a full new needs assessment undertaken by an approved needs assessor and a reassessment ‘on the papers’ where certain information is given to the System Governor.[54]

3.61Information available about the Support at Home program through the Department’s website outlines the Single Assessment System and notes that if someone receiving aged care services find that their needs increase in future, ‘they would be reassessed into a new Support at Home classification with a higher budget’.[55]

Provider concerns

3.62The Department noted in their public information about Support at Home that:

Given the fluctuating nature of care management needs, funding for care management will be combined at the service provider level. This will enable providers to meet needs for care management support as they arise. 10% of each participant's quarterly budget will be set aside for care management delivered by their service provider.[56]

3.63Care management is defined in the Department’s Support at Home information as including:

planning and coordinating services

checking in with participants to ensure they are being well supported

clinical advice and practical support to address any changes in need or issues that arise

providing support and education where needed.[57]

3.64Helping Hand Aged Care Inc. was one of the providers of in home aged care services who raised concerns about the proposal in the bill to reduce the cap on care management fees to 10 per cent from 20 per cent.

3.65In its submission, Helping Hand Aged Care Inc. wrote that ‘the obvious result of these cuts is the reduced level of care management service being provider by providers’ and the organisation noted that for low-level packages this would be achievable but for higher needs clients lower care levels would result in risks to clients.[58]

3.66Anglicare Australia also commented on the reduction in the cap on management fees, writing that while under the new arrangements overheads of service provider organisations will be considered in unit pricing for services, there is ‘little reassurance that service fees will reflect the real cost of delivering services’.[59]

3.67Additionally, Vision Australia raised concerns that it works with a ‘low-incidence consumer cohort’ that requires services from ‘a highly trained workforce with specialised expertise’. Further, it noted that there is often a greater need to travel to the consumer’s location as most of the services it provides cannot be provided in a clinic.[60]

3.68Vision Australia acknowledged that the Department is considering supplementary grant funding in thin markets but noted that funding could be based on the category within the aged-care provider specialisation framework. Vision Australia raised that disability is not a recognised provider specialisation, and as such noted that it ‘does have concerns that the impact of thin markets on sustainable service delivery for this cohort has not been fully realised’.[61]

3.69A further provider concern raised, particularly by regional and remote providers, was that transport costs often increase the cost of services. Mr Stewart, Chief Executive Officer of Helping Hands Aged Care Inc., told the committee that delivering Support at Home services would be challenging in regional Australia:

The cost of delivering services in the regions is obviously a lot more than what it is in metropolitan cities ... As a not-for-profit organisation, we are very conscious of not wanting to eat into people's packages by charging them significant amounts for travel and mileage, so we absorb a fair bit of that. We're really hopeful that, in the IHACPA studies, the extensive costs of providing Support at Home services in regional areas are recognised and that services are appropriately funded … we are concerned that if that's not done properly then the viability and sustainability of those programs are certainly at risk.[62]

3.70The Department advised the committee that the 10 per cent care management cap was a decision of Government, reached through consultation with providers and has been informed by the way providers manage levels of in home care:

The 10 per cent care management equates to somewhere in the order of an hour a month for someone on the lowest level of supported home, up to somewhere in the order of six hours a month for a person on the highest level of supported home. But the way that the fund was determined, after consultation with providers, was to have a pooled fund, effectively, for a service provider. So, across all of their client base, 10 per cent of all of their clients' budgets is pooled, and a service provider can draw down on that funding, so they will invoice after care management is delivered. It has flexibility about how that care management fund is used across their clients. That was really to reflect the fact that it's lumpy. Some people need more when they first start or when something goes wrong, and in the in-between times they may not need as much, and it's hard to predict who and when.[63]

3.71Mr Nick Morgan, Assistant Secretary at the Department, explained the breakdown of support for levels of packages with the 10 per cent care management cap:

The 10 per cent care management arrangement would pay for from somewhere around one hour a month for the lowest levels of packages up to, for the highest budget, around six hours a month. On top of that there's a loading that's provided in addition to that 10 per cent in respect of people who have been referred by a care finder, are homeless or at risk of homelessness, are a care leaver, are a First Nations person or are in receipt of a veterans supplement. That's equivalent to one extra hour per month of care management.[64]

3.72Mr Morgan advised the committee that the 10 per cent management cap was not inconsistent with information from the discussions the Department had held with providers.[65]

3.73Mr Morgan thought that the concerns providers had raised with the committee were based in care management fees, and this was consistent with the feedback the Department had received:

A lot of the feedback I'm receiving is that it goes to the use of the care management fees. The feedback I'm getting is 'that'll make us unprofitable'. The feedback hasn't been so much about the level of care management being delivered, so I'm not sure. The feedback we've received is that it's somewhere in the order of two to four hours of care management, and that's the order of magnitude that we're talking about here.[66]

3.74In response to concerns from providers about the cost of services, evidence from the Independent Health and Aged Care Pricing Authority (IHACPA) about their work assessing pricing for Support at Home services showed that significant research has been done to inform pricing assessments for services providers can charge. Professor Michael Pervan, CEO of IHACPA, told the committee:

… we undertake repeated costings studies, why we put draft frameworks out for consultation into the sector and why we meet with stakeholders from the sector to get better information. For example, we had a fantastic meeting only 24 hours ago with the Australian Community Transport Association about a data exercise they're engaged in with a local university. We will draw from that as well as many, many other data points, not just our costing study but also the data that the department holds around these services and independent data, such as the dataset that I've just mentioned from community transport, as well as benchmarking across with the other similar services … such as the NDIS and veterans services. We get to a level of confidence where we are happy to present our recommendations to the pricing authority, our board, for recommendations to the minister, based on all of those cross-checks and quality assurance measures.[67]

3.75Professor Pervan told the committee that the data used to determine pricing is taken from across the aged care sector, including providers of all sizes. Professor Pervan explained that providers are consulted as part of the process of determining pricing:

Part of our practice is to publish not just the price but the data we've gathered, what that means and what it tells us and then to follow that up with a pricing framework that, first of all, is issued in draft to the sector and to the public at large, which maps out the issues we'll consider in pricing, and gets that feedback after 45 days, our standard practice. Then we'll develop a pricing formula based on the data that has already been out for consultation, so we have multiple levels of validating the data and our processes. When we issue a price, we'll publish that as well as the way we calculated it. In addition to those big headline consultative and engagement processes we meet continually with stakeholders, both peak bodies and individual providers, and welcome that kind of input and direct engagement.[68]

3.76The IHACPA information about in-home aged care discusses pricing for the Support at Home program, and notes that the program will have a defined service list that will provide the care and services available. In its work making a recommendation on pricing for the Minister for Health and Aged Care, IHACPA ‘undertake cost collections to grain a greater understanding of the resources used to deliver aged care services and how much they cost’.[69]

3.77As part of determining prices for services, the IHACPA online material notes that ‘Prices for services on the Support at Home service list will include all in-scope costs associate with delivering the service such as labour, transport, consumables and administration.’[70]

Current in home care transition arrangements under Aged Care Bill 2024

3.78In terms of the relationship between CHSP and Support at Home, Mr Ian Yates AM, Acting Inspector-General of Aged Care, explained to the committee that Support in Home is ‘significant improvement on home-care packages’ but that there is not one seamless home-care program with CHSP existing separately to Support at Home. Mr Yates noted that ‘government has made a decision that [an integrated home care package] will not happen before 2027’.[71]

3.79The Government decision around the future of CHSP was outlined in evidence given to the committee by the Department at the 3 October Canberra hearing. Ms Thea Connolly, First Assistant Secretary, Home and Residential Division told the committee that:

The CHSP will largely continue as it is, as a grants program administered by the Commonwealth. There is limited information at the current point in time in relation to what that will look like under the new Age Care Act. We recognise that. However, we are starting our engagement with CHSP participants and with providers, including with some outreach on 22 October where we will talk to people about how the CHSP will operate under the new Aged Care Act … from a client's perspective, it will largely continue very similarly to what it is at the moment. There will be some changes that we anticipate talking to people about on the 22nd—in particular around service list arrangements. We'll be looking to align the service list more closely for in-home care across both the Support at Home program and the CHSP where it's appropriate to do so … we're looking to minimise the impact on clients at the current point in time—noting that the government's agreed that CHSP would not transition to Support at Home before 1 July 2027.[72]

3.80The committee also heard evidence relating to the cost for individuals of transitioning from CHSP and home care support packages into Support at Home. Mr Lye, Deputy Secretary, explained that when transitioning individuals currently receiving support to the Support at Home package, there would be no additional cost for individual co-contributions for services:

… everyone who is currently in the system in the Home Care Packages Program or the Commonwealth Home Support Program will pay the same or lower fees than they currently do through their whole all-aged care journey, including into residential care. That includes people who have been assessed and are on the waiting list for services. The principle here is: we're trying to make it clear to the existing population that they won't be captured by the new fee structure ...[73]

3.81Dr Hartland, Special Advisor, Home and Residential Division, told the committee that a number of protections are in place to protect people transitioning to the Support at Home packages. These include:

Grandfathering provisions which will ensure people already approved or using a Home Care package and transferring to a Support at Home package will not see a change in cost;

Support at Home will see people pay a percentage of the services they use, as compared to a fee no matter what services were accessed under the current Home Care package; and

A lifetime contribution cap of $130,000, or four years cap, which applies across Support at Home and residential care for non-clinical services.[74]

Enforcement and protection measures

3.82Evidence to the committee illuminated concerns regarding the enforceability of registered provider obligations; penalties for a provider’s breach of the duty of care; regulation of digital providers; and whistleblower protections. These are discussed below.

Enforceability of registered provider obligations under the Statement of Rights

3.83In its submission, the Office of the Inspector-General of Aged Care (OIGAC) noted that clause 23 of the bill seeks to establish a rights-based framework through the Statement of Rights.[75]

3.84The OIGAC explained that under subclause 24(2), providers of funded aged care services would have a positive duty to take ‘all reasonable and proportionate steps’ to act compatibly with these rights.[76]

3.85Additionally, it highlighted that clause 144 creates a registration condition where providers must demonstrate that they understand the rights under the Statement of Rights and have existing practices to ensure that the delivery of their aged care services are in line with subclause 24(2).[77]

3.86However, some inquiry participants particularly noted their concerns regarding subclause 24(3),[78] which provides that the rights are not enforceable in a court or tribunal.[79]

3.87For example, Peter F, a lived experience witness, told the committee that in his opinion, subclause 24(3) says to individuals that ‘these are your rights, but you can’t use them’.[80]

3.88Similarly, the Human Rights Act Campaign submitted that the full benefits of the rights are ‘watered down’ by subclause 24(3).[81] Relatedly, the OIGAC described that the approach taken to safeguard individuals’ rights as ‘largely aspirational’ and raised that the ‘available pathways for individuals to understand and assert their rights lack the necessary vigour to drive real change’.[82]

3.89However, Ms Mel Metz, Assistant Secretary of the Legislative Reform Branch within the Department, explained to the committee that subclause 24(3) aligns with the Royal Commission’s intention in relation to upholding the rights:

The royal commission didn't envisage a direct path to litigation from the rights, and so that is reflected in the bill. Nor do we think that that's appropriate because there is a spectrum of breaches of rights, and different breaches would necessarily lead to different responses.[83]

3.90The Explanatory Memorandum also outlines that the Statement of Rights is broad, and a one-size-fits-all response to a possible breach would not be appropriate.[84]

3.91Consequently, the OIGAC observed that that the primary mechanism to invoke an individual’s rights is to lodge a complaint with the Complaints Commissioner. Yet, the OIGAC considered that it was unclear what positive actions are available for the Complaints Commissioner to take in order to assert an individual’s rights.[85]

3.92Occupational Therapy Australia similarly echoed that the bill does not ‘go far enough on enforceability, with the current arrangements relying on the adequacy of the complaints process to address breaches of rights under the Act’.[86]

3.93However, Ms Metz, Assistant Secretary, further explained the complaints process to the committee by clarifying the available enforcement mechanisms to the Complaints Commissioner:

People can go directly to the complaints commissioner, or if they don't get a satisfactory resolution at the provider level they can also escalate to the complaints commissioner … Where a complaint is made that indicates there may also be a breach of a registration condition or obligation, the commissioner can then take regulatory action. Some rights may be of such significance that they also breach the code of conduct or the quality standards, and there are registration conditions that relate to those things. They have civil penalties attached to them under section 144 of the bill.[87]

3.94Some inquiry participants also commented on the independence of the Complaints Commissioner. Witnesses such as Ms Patricia Sparrow, CEO of Council on the Ageing Australia, and Gwenda, a lived experience witness who appeared in Port Lincoln, both welcomed the appointment of an independent Complaints Commissioner.[88]

3.95The Department also clarified that establishing the Complaints Commissioner as a statutory appointment within the Commission ‘reflects and directly responds’ to both stakeholder feedback and to recommendations from the Royal Commission regarding the ‘independence, transparency, and accountability of complaints handling by the Commission’.[89]

3.96Further, the Department noted that the First Nations Aged Care Commissioner (FNACC) is expected to be explicitly referenced in the new Act and associated rules.[90] The Summer Foundation commented that the FNACC would be a ‘welcome addition to safeguarding the rights of First Nations people in aged care settings’[91] and the National Aboriginal Community Controlled Health Organisation submitted that it strongly supports the FNACC as an ‘independent advocate’ for Aboriginal and Torres Strait Islander people.[92]

Duty of care and associated penalties

3.97The Explanatory Memorandum provides that Part 5, Chapter 3 of the bill introduces statutory duties imposed on registered providers, certain responsible persons of registered providers and digital platform operators, which also includes a regime of civil penalties.[93]

3.98However, inquiry participants recognised a change from the bill’s Exposure Draft, which originally included both civil and criminal penalties for registered providers who breached their duty of care.[94]

3.99Submitters held mixed views on the removal of criminal penalties in relation to providers’ duty of care. For instance, Neurological Alliance Australia contended that the removal of criminal sanctions weakens safeguards:

Removing criminal sanctions will mean providers will face lesser penalties for breaches of their duty of care to their clients and residents and is a fundamental weakening of the safeguarding framework recommended by the Aged Care Royal Commission.[95]

3.100This was echoed CEO of Advocacy Tasmania, who stressed that criminal penalties should be reintroduced to the bill:

… the bill must reintroduce criminal and civil penalties. There must be the strongest of deterrents for serious harm by aged-care providers. The aged-care royal commission recommended this, and older people and their supporters expect nothing less of our government. They want protection. Without it, the status quo will be maintained.[96]

3.101Conversely, some inquiry participants welcomed the removal of criminal penalties due to the potential adverse impacts that they may have had on the aged care workforce.[97]

3.102For example, UnitingCare Australia expressed their support for the removal of criminal penalties, as it argued that it will significantly reduce the risk of skilled staff leaving the sector and will ensure that qualified personnel remain on boards and in leadership roles.[98]

3.103This was echoed by Aged and Community Care Providers Australia, who identified that criminal penalties could ‘worsen the already critical [aged care] workforce shortages’.[99]

3.104Mr Trevor Johnson, CEO of Eyre Peninsula Old Folks Home Inc., highlighted the negative impacts that criminal penalties would have on his own ability to attract and maintain a workforce:

One of the things that has scared my people is the thought that the talked-about criminal penalties could be reintroduced in the Senate. Can I just say clearly, as I've put in the submission: we will lose staff immediately, and I will be one of those people, if the government decide to impose criminal penalties for aged-care workers. We're having enough trouble recruiting people into aged care right now without criminal penalties.[100]

3.105In her Second Reading Speech, the Minister also emphasised that the existing civil penalties in the bill’s provisions should not deter ‘good people who understand the responsibility that comes with caring for older people … from taking on positions of responsibility because of these new duties’ within the duty of care framework.[101]

Digital providers

3.106Some inquiry participants raised concerns regarding the obligations imposed on digital platform providers of aged care services.[102] For example, Hireup, a digital platform National Disability Insurance Scheme (NDIS) provider, noted that the bill proposes direct regulation only for registered providers, leaving ‘major loopholes for unregistered and unregulated service providers, including those using complex networks of subcontractors and digital platforms’.[103]

3.107Mr Peter Willis, General Manager of Attendant Care at Hireup, elaborated at a public hearing that the bill’s provisions do not require digital platforms to:

… comply with the strengthened aged-care standards that require them to meet certain conditions to provide support. They don't require digital platforms to submit to audit or to any direct monitoring from the commission, and they're not clear on what platforms need to report to the commission or whether they are going to report on serious incidents.[104]

3.108Mr Willis contended that consequently, there could be ‘really serious injuries or cases of abuse or neglect’ that could occur without digital platforms having ‘any direct line to the commission or the commission have any direct line to the platform’.[105]

3.109Relatedly, the Health Services Union submitted that as the economy across aged care and the NDIS continues to grow, the issue concerning the ‘proper role of digital platforms and their regulation should be addressed more thoroughly’.[106]

3.110The Department clarified that under the bill, online platforms in aged care will in fact ‘have to meet explicit obligations for the first time’ and that operators of aged care digital platforms may be subject to civil penalties if they fail to meet the following obligations:

notify the Aged Care Quality and Safety Commissioner that they are operating a platform;

check and display whether providers representing via the platform that they can deliver services in the Commonwealth aged care system are registered, their registration categories and whether a banning order is, or has been, in force against the provider, including an NDIS banning order;

implement a complaints management system and an incident management system and manage incidents in accordance with these systems to support registered providers in meeting their conditions of registration;

display on the platform, a summary and explanation of the complaints management and incident management systems;

prominently display the Aged Care Statement of Rights to older people seeking to access aged care services through the platform;

report to the Commissioner, the Department of Health and Aged Care, the Complaints Commissioner or the Aged Care Inspector-General, any information which is prescribed for them in the rules;

keep and retain records and disclose information contained in those records in accordance with the rules.[107]

Framework for whistleblower protections

3.111Chapter 7 of the bill provides for whistleblower protections to ensure individuals who make disclosures about contraventions, or suspected contraventions, of the bill are protected from victimisation, and will not be subject to criminal, civil or administrative liability.[108]

3.112Some submitters identified that the bill’s whistleblower provisions overlap with existing legislation.[109] For example, the Commonwealth Ombudsman identified that the provisions overlap with existing Commonwealth, State and Territory whistleblower protection schemes, for both the private and public sector, such as the Public Interest Disclosure Act 2013 (Cth) and the Corporations Act 2001 (Cth).[110]

3.113However, the Commonwealth Ombudsman submitted that whistleblower provisions would improve the existing whistleblower protections in place under the Aged Care Act 1997, as it clearly sets out protections in a way that ‘makes the mechanics of the scheme easy to identify’.[111]

3.114Provisions within clause 547 provide a list of categories of people that disclosures qualifying for protection can be made to. These are:

An Appointed Commissioner or a member of the staff of the Commission;

The System Governor, or an official of the Department;

A registered provider;

A responsible person of the registered provider;

An aged care worker of a registered provider;

A police officer; or

An independent aged care advocate.[112]

3.115Inquiry participants recognised the need for whistleblower protections within the aged care system but highlighted concerns that disclosures can be made to aged care workers.[113]

3.116For example, Ms Silvia Alberti, Chief Operating Officer of Baptcare Ltd, told the committee that her organisation strongly supports the whistleblower provisions in spirit but noted that people who receive disclosures need to understand how to appropriately manage them:

The act suggests that any aged-care worker could take a disclosure. We don't think it's possible, across Australia, to train thousands of people to take these disclosures and know how to act on them appropriately and swiftly. So we don't think that that's actually a good position to put our staff in, and it's not a position that we would like to put the public, or anyone making a protected disclosure, in. We believe these are really important disclosures, and the people that take them need to understand very carefully how to manage them appropriately.[114]

3.117Aged and Community Care Providers Association echoed that it is unreasonable to expect that all aged care workers should be able to receive a qualifying disclosure, providing an example where ‘part-time workers who only recently started work in the aged care sector may not be aware that a qualifying disclosure is being made to them’.[115]

3.118Alternatively, both Anglicare Australia and the Aged and Community Care Providers Association recommended that aged care providers should instead be required to identify specific people or roles who are authorised to receive a qualifying disclosure.[116]

3.119Ms Metz, Assistant Secretary at the Department, acknowledged provider concerns raised throughout the inquiry in relation to who can receive protected disclosures. She informed the committee that the categories of people who can receive protected disclosures were designed to be intentionally broad, as:

… vulnerable older people may not necessarily know who they have to make a disclosure to in order to get protections. The intent was that we would keep those categories as broad as possible to ensure that the broadest possible scope of disclosures would receive protections as whistleblower disclosures.[117]

3.120Ms Lauren Hutchins, Assistant Secretary of the New South Wales, Australian Capital Territory and Queensland Branch of the Health Services Union, similarly told the committee of the importance of aged care residents being able to disclose to the worker that they feel most comfortable with to ensure that concerns are addressed promptly:

We believe that, in the event that a resident wishes to disclose, they should be able to disclose to the worker that they feel most comfortable with, the person they've built up trust and a relationship with. You can't wait for someone who's on shift who might be nominated by an employer to receive that information. Events happen at any time of day and at any point within care, so the ability for someone to reach out to the person that they feel comfortable with is absolutely paramount if we are to ensure that we're addressing concerns in real time.[118]

3.121Ms Metz also recognised that there is a balance that needs to be struck between ‘clarity and ease of administration of a whistleblower framework and protecting a broad range of people who want to come forward with information’.[119]

Matters related to the Aged Care Rules

3.122The committee received evidence in relation to the details and operation of the Aged Care Rules 2024 (the Rules) that are referred to within the bill’s provisions. Some of these key matters are discussed below.

Visibility of the Rules

3.123Some inquiry participants raised concerns that key matters are to be dealt with by the Aged Care Rules 2024 (the Rules).[120] Specifically, the OIGAC observed that there is a degree of uncertainty around how many of the clauses will operate, as several critical clauses throughout the bill rely upon additional provisions to be set out in the rules.[121]

3.124Additionally, Peter Willcocks, a lived experience submitter, queried in his submission:

What are the ‘rules’? Nobody knows because the Act is so open ended that we do not know how future administrations and ministers might use the ‘rules’ for a ‘great idea’.[122]

3.125National Seniors Australia also identified that the absence of the Rules presents a fundamental difficulty in reviewing the bill. It also suggested that the Aged Care Quality and Safety Commissioner (the Commissioner) should be empowered to consider proposed amendments to the Rules to ‘recognise that we are unlikely to get everything right in the very short time the Rules are being created’.[123]

3.126Mr Lye, Deputy Secretary, acknowledged that there is a high level of interest in the Rules, but clarified that they can only be finalised and tabled following the passage of the bill.[124] Mr Lye further explained that:

This committee process and changes made during the passage of the bill will need to be considered in developing the rules. Rules development typically follows development of primary legislation for this reason and because the primary legislation sets the parameters of what can be included in the rules. This is not uncommon.[125]

Rules relating to Chapter 4 of the bill

3.127UnitingCare Australia specifically called for the public release of the Rules for Chapter 4,[126] which provides the arrangements for funding of aged care services, including what the Commonwealth will pay, and what an individual can be asked to pay based on a means test.[127]

3.128UnitingCare Australia emphasised that the release of the Rules would assist providers to prepare for the transition to the new legislation (transition concerns are further explored later in this chapter).[128]

3.129Further, the Older Persons Advocacy Network also commented that the absence of the Rules contained in Chapter 4 makes it difficult to ‘fully evaluate the impact and acceptability of the proposed funding and co-contribution model on older people’.[129]

3.130The Department provided the committee with an overview of what can be expected in the Rules regarding the funding of aged care services, which can be viewed on the committee’s website.[130] It noted that the Rules have not yet been finalised and that any policy included in the document is subject to change.[131]

Rules relating to consent for restrictive practices

3.131Submitters acknowledged that the consent framework regarding restrictive practices will be contained within the Rules. Aged Care Justice, Aged Care Reform Now, Carers’ Circle and Independence Matters explained that the current model allows for ‘a wide range of people without any expertise to consent to a restrict practice on behalf of a care recipient’ thereby risking the increase of ‘unnecessary restrictive practices and potential human rights violations’.[132]

3.132For example, the Older Persons Advocacy Network reported that carers and family members who are asked to provide ‘informed consent’ for the use of restrictive practices often feel ‘uniformed and pressured into consenting by aged care providers and sometimes by doctors prescribing psychotropic medication’.[133]

3.133As such, Aged Care Justice, Aged Care Reform Now, Carers’ Circle and Independence Matters recommended that the Rules should provide that restrictive practices must be authorised by an independent clinical expert following the assessment of the proposed use of the practice.[134]

3.134The Queensland Public Advocate, Dr John Chesterman, similarly suggested a senior practitioner authorisation model for restrictive practices, where ‘clinical expertise is at the forefront of any restrictive practice authorisation’.[135] This model was also supported by Relationships Australia.[136]

3.135Dementia Australia submitted that in the absence of such an authorisation model, the bill and Rules must ensure that there is ‘enhanced oversight and transparent reporting of restrictive practice implementation’.[137]

Aged Care Quality Standards

3.136Whilst the Aged Care Quality Standards (the Quality Standards) are due to be formally legislated by the Rules, inquiry participants were able to comment on the particulars of the Quality Standards as draft guidance was released by the Aged Care Quality and Safety Commission.[138]

3.137According to the Explanatory Memorandum, clause 15 of the bill provides that the rules may prescribe standards relating to the quality of funded aged care services that are delivered by a registered provider. It conveyed that this clause establishes a framework to strengthen and replace the existing Quality Standards that were introduced on 1 July 2019.[139]

3.138The Explanatory Memorandum further explained that the new Quality Standards address Recommendation 19 of the Royal Commission,[140] which called for an urgent review and amendment of the Standards (if appropriate).[141]

3.139The Aged Care Quality and Safety Commission would be responsible for regulating providers against the new Quality Standards, which ‘aim to ensure that individuals accessing funded aged care services receive safe and quality care’.[142]

3.140The Australian College of Nursing commended the strengthened Quality Standards that would be introduced in the Rules.[143] Additionally, Mrs Magriet Raxworthy, CEO of Dieticians Australia, told the committee that her organisation welcomes that the strengthened Quality Standards include nutritional needs and the preferences of individuals.[144]

3.141However, Ms Raxworthy also noted that the Quality Standards will not benefit older people receiving home delivered or centre-based meals, as the standards relating to food and nutrition only pertain to residential aged care.[145]

3.142Additionally, some submitters raised that the Quality Standards do not contain a specific standard relating to workforce. For example, the Australian Nursing and Midwifery Federation expressed concern that the Quality Standards do not provide for a ‘workforce quality standard outlining the basic conditions that should be provided to ensure workers are supported to deliver high-quality care and achieve the objectives of the bill’.[146]

3.143This sentiment was shared by Aged Care Justice, Aged Care Reform Now, Carers' Circle and Independence Matters, who contended that Quality Standards should include elements like training, numbers, professional obligations, Work Health and Safety rights and worker voice.[147]

Transition timeline

3.144Many inquiry participants acknowledged that the implementation of the bill’s provisions will require aged care providers to update existing systems and procedures, and as such called for support to assist them in their transition.[148]

3.145For instance, Anglicare Australia stressed that the bill marks ‘once in a generation’ reform and that changes should not be rushed.[149]

3.146Ms Jude Emmer, Chief Executive Officer of Wesley Mission Queensland, similarly cautioned against rapid implementation of the legislation:

… I believe it's such a big change for the sector that we need to be careful and do it well and do it once. We don't know the unintended consequences of rushing legislation and the implementation of such without really understanding and unpacking all the rules.[150]

3.147Relatedly, Silverchain recommended that there should be a 12-month transition period to ensure that providers are able to comply with the Act once all the Rules and guidelines have been released.[151]

3.148RSL LifeCare also called for a 12-month transition period following the release of the Rules, contending that it would allow providers to ‘better understand their new obligations, revise policies, implement staff training, recruit necessary personnel and update IT systems’.[152]

3.149In its submission, the Aged Care Quality and Safety Commission discussed the support that it and the Department will provide to aged care providers to assist in the transition period:

The Commission is also working closely with the Department to streamline the transition to the new registration framework for existing approved providers and grant-funded providers. A suite of sector communications, resources and supporting materials is being jointly developed to support providers, and the transition process will ensure that providers are able to continue delivering care uninterrupted throughout the transition period.[153]

3.150Mr Lye, Deputy Secretary, also acknowledged the important role that the Department will have in supporting providers to transition to the new arrangements:

… I think the evidence is clear from providers: they are anxious about the changes that we are seeking to make and to have the parliament consider. It is clear, particularly when you hear evidence from smaller providers or people outside capital cities and not necessarily peak bodies, that people are anxious about the detail of what we're trying to do. So we—the department—have an obligation to work harder, to communicate better and to get into that detail, to satisfy their desire for knowledge around these particular operational policy details which are incorporated in the reform. We recognise it; I think it's been clear in the evidence given. We understand that we've got a challenge to meet that, and we're fully prepared to do that.[154]

3.151Mr Greg Pugh, First Assistant Secretary of the Reform Implementation Division, also provided an overview of the Department’s communication strategy with providers. He told the committee that the Department had released a reform road map, hosted webinars, and established other communication channels such as the Your Aged Care Update newsletter to keep the sector updated.[155]

Inclusion of diversity groups in the Statement of Principles

3.152Under the bill’s Statement of Principles, subclause 25(4) provides that the aged care system offers available, culturally safe, appropriate, trauma-aware and healing-informed funded aged care services if required by an individual and based on the needs of that individual, regardless of the individual’s location, background and life experiences.[156] A legislative note in the bill clarifies that this may include the following individuals who:

(a)are Aboriginal or Torres Strait Islander persons, including those from stolen generations; or

(b)are veterans or war widows; or

(c)are from culturally, ethnically and linguistically diverse backgrounds; or

(d)are financially or socially disadvantaged; or

(e)are experiencing homelessness or at risk of experiencing homelessness; or

(f)are parents and children who are separated by forced adoption or removal; or

(g)are adult survivors of institutional child sexual abuse; or

(h)are care-leavers, including Forgotten Australians and former child migrants placed in out of home care; or

(i)are lesbian, gay, bisexual, trans/transgender or intersex or other sexual orientations or are gender diverse or bodily diverse; or

(j)are an individual with disability or mental ill-health; or

(k)are neurodivergent; or

(l)are deaf, deafblind, vision impaired or hard of hearing; or

(m)live in rural, remote or very remote areas.[157]

3.153The committee heard concerns from LGBTIQ+ Health Australia that diversity groups in this list – including lesbian, gay, bisexual, transgender (LGBTI) people – are only included in the bill as a legislative note. It submitted that this is in contrast to the existing Aged Care Act 1997, which explicitly identifies LGBTI people (amongst others) as a special needs group.[158]

3.154LGBTIQ+ Health Australia also questioned whether the legislative note would prevent future reference to these groups in regulations or future amendments to the bill, as these groups are ‘not a legislative clause that can be referenced’.[159]

3.155 LGBTIQ+ Health Australia contended that if this is the case, then it is problematic and as such called for the bill to explicitly identify diversity groups within the bill’s provisions, as opposed to a legislative note.[160]

Worker screening

3.156The Explanatory Memorandum explains that the bill would require the Commissioner to establish an aged care worker screening database. The database would be an up-to-date record of individuals who have been assessed under aged care worker screening laws not to pose a risk, or to pose a risk, to people accessing funded aged care services.[161]

3.157The Aged Care Workforce Remote Accord acknowledged that the bill would facilitate the establishment of a nationally consistent worker screening scheme but emphasised that where background checks do raise issues which may be of concern, the best-placed entity to make a decision regarding employee suitability is the employer.[162]

3.158It stressed that this is particularly important for First Nations people, who ‘are often best positioned to provide culturally safe care to other First Nations people’ and further informed the committee that:

The provision of aged care in remote areas is deeply intertwined with cultural sensitivities, community trust, and local knowledge. Removing the capacity of service providers to exercise discretion regarding worker screenings could prevent the most appropriate individuals from being engaged in caregiving roles, thus compromising the cultural safety of care for elders in these communities.[163]

3.159Therefore, the Aged Care Workforce Remote Accord emphasised that it is vital that discretion and mitigation for remote worker screenings remain with remote service providers to ensure the continuation and ongoing improvement of culturally safe care, as well as workforce sustainability, in remote areas.[164]

3.160Discussing privacy and safety concerns relating to the database, the Business Council of Australia identified that the screening database may contain personal information which could raise ‘personal safety and security risks for individuals, providers and responsible persons’ if the information was made public.[165]

3.161As such, the Business Council of Australia emphasised that the Commissioner must be bound by ‘appropriate railguards’ to ensure that information is not ‘unreasonably disclosed’.[166]

3.162Further, addressing worker screening requirements more broadly, Ms Hutchins of the Health Services Union, identified a positive registration scheme as an outlier from what has been implemented from the Royal Commission recommendations.[167] She told the committee that:

Our members want to have a scheme in place that ensures that there is a minimum standard for personal care workers that is a positive standard … this is about saying that we have qualified professional carers who are supported, who continue to train and continue to build on those skills.[168]

3.163Similarly, Ms Annie Butler, Federal Secretary of the Australian Nursing and Midwifery Federation, emphasised the importance of a positive registration scheme:

… a positive registration scheme sets out the minimum standard …for entry to practice and then the standards that are required for ongoing and continuing practice … if you're putting your mother into residential aged care or if you're an older person getting care services at home, you know that wherever you are in the country, you're getting a person who has a certain standard of practice in care and you know that you can be safe and confident in the level of care that is going to be delivered. We think that older Australians across the country deserve that.[169]

Access to aged care for people aged under 65 years

3.164Clause 58 of the bill provides the necessary criteria for an eligibility determination for an aged care needs assessment. It provides that the System Governor must not make an eligibility determination for an assessment, unless the System Governor considers that, among other factors, the individual is:

Aged 65 or over; or

Is an Aboriginal or Torres Strait Islander person that is aged at least 50; or

Is homeless, or at risk of homelessness, and is aged at least 50.[170]

3.165Further, if the individual is under 65, the individual must have elected to be provided with aged care services and must have been informed prior to making that decision of any other relevant services that meet their needs.[171]

3.166Submitters held mixed views regarding the age criteria for individuals entering aged care. For instance, the Young People In Nursing Homes National Alliance outlined that over 95 per cent of young people living in permanent residential aged care are NDIS recipients.[172]

3.167Young People In Nursing Homes National Alliance stressed its strong belief that ‘no person under 65 with a disability should be eligible for aged care services’[173] and noted that the prospect of ‘cranking up the flow’ of younger people into residential aged care was ‘deeply disappointing.’[174]

3.168The Department noted that the bill’s provisions do not ‘expand access to aged care for younger people’, clarifying that instead ‘they codify the established ‘exceptional circumstances’ where early entry into aged care is considered appropriate’.[175]

3.169Conversely, Mr James Atkinson, CEO of Aboriginal Community Elders Services, told the committee that he believed it is important for the age exemptions to remain in the bill. Mr Atkinson explained that this was due to the health needs and issues amongst Aboriginal and Torres Strait Islander populations:

What we're seeing is a higher rate of young people—and there are obviously a lot of contributing factors to this—who are suffering from chronic disease issues, which are coming on at an earlier age than anticipated. Although we're living longer, as Aboriginal and Torres Strait Islander people, we're living with more complex health needs and issues … I certainly think it's important, because what we're seeing is a greater spread of those health issues.[176]

3.170Ms Melisa Coveney, Principal Solicitor at Darwin Community Legal Service, similarly expressed her support for the age exemptions as they relate to First Nations people in the bill:

I think [the age exemptions for First Nations people] are very important. I'm not First Nations, and I don't intend to speak on their behalf, but from my perspective they're very important because the life expectancy of First Nations people is much lower than non-First-Nations people, and they have a lot more health conditions, which means they have a need for aged care much earlier than mainstream populations. So I think it's extremely important.[177]

Committee view

3.171The committee thanks all participants for their input to the inquiry and acknowledges all individuals and organisations that provided detailed submissions or appeared at the nine public hearings across Australia. The committee specifically recognises the significant contributions of lived experience submitters and witnesses who shared their stories with the committee.

3.172The committee notes that considerable engagement and consultation has occurred in preparing this bill to ensure the needs of older people are at the centre of the aged care system.

3.173The committee acknowledges the significant consultation on the bill by the Department of Health and Aged Care. This included direct engagement with peak bodies, the Aged Care Council of Elders, and the National Aged Care Advisory Council, as part of initial consultation on the exposure draft.

3.174The exposure draft of the bill was released for public consultation in December 2023 for four months. This consultation included:

Face-to-face and virtual workshops, including specific sessions for culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander people, which were attended by over 1000 people;

Three public webinars, with over 9600 people in attendance;

Roundtable discussions and engagement with aged care experts, advocates, providers and worker representatives; and

Almost 14 500 separate points of engagement, including over 440 submissions and 1500 survey responses.

3.175The committee further notes that, in the course of its inquiry, it heard from 153 witnesses at its nine hearings, which encompassed hearings in every state and territory, including in regional areas. This included 28 witnesses with lived experience as well as researchers, advocates, providers and others affected by the changes.

Ensuring the financial sustainability of the aged care sector

3.176With an ageing population, it is critical to have a sustainable financial funding system. Indeed, in the next 40 years, the number of Australians aged over 65 is expected to more than double, with those aged over 85 to triple. The current funding arrangements are not sufficient to ensure a sustainable aged care system that can deliver quality care for Australians into the future, and the committee acknowledges the significant evidence that changes are urgently needed.

3.177The committee notes that the proposed funding changes are based on the recommendations of the Aged Care Taskforce, which developed options for a system that is fair and equitable.

3.178The committee acknowledges the importance of ensuring that the providers, individuals, and current and future governments work together to make the aged care system sustainable. This is ultimately necessary to ensure that into the future, Australians can receive the care they need and deserve.

3.179The committee notes the concerns that inquiry participants have raised about the level of individual co-contributions, and what consumer protections would be in place under the new system. However, the committee is of the view that the co-contributions, as set out in the bill’s provisions, are an important step to making the aged care system sustainable now and for future generations who will require aged care services.

3.180The committee agrees with inquiry participants that details regarding the Support at Home program require close consultation with providers and the community, particularly regarding caps and pricing for services, and that enhanced communication around consumer protections are needed.

3.181The committee strongly encourages the government to give consideration to the concerns raised by witnesses, particularly advocates and lived experiences witnesses, about the proposed annual caps on cleaning and gardening services.

3.182Additionally, the committee encourages the government to create guidance materials for individuals and providers regarding the transition of current packages, including the Commonwealth Home Support Programme, to the new Support at Home program.

Appropriate enforcement and protections

3.183The committee heard concerns about the effectiveness of enforceability and protection mechanisms in the bill as they relate to the Statement of Rights, the duty of care for providers, the regulation of digital platform providers, and whistleblower protections.

3.184The committee understands that the Statement of Rights within the bill is fundamental to ensuring that older people are put back at the centre of the aged care system. The committee acknowledges that it was not the Royal Commission’s intention for these rights to be enforceable via litigation. As such, the committee is of the view that the Statement of Rights is an appropriate mechanism to support older people and their families to have conversations about the care that they deserve.

3.185Further, the committee notes that providers must also take steps to act in accordance with the Statement of Rights, and that if they breach any of these rights, then the Aged Care Quality and Safety Commission has appropriate enforcement mechanisms at its disposal to respond. The committee further notes that the bill provides for an independent Complaints Commissioner, as recommended by the Royal Commission, to ensure accountability for complaints management.

3.186The committee acknowledges the concerns of some inquiry participants that providers will not be subject to criminal penalties for breaching their duty of care. The committee deems that the civil penalties in the bill’s provisions strike a balance of holding providers to account whilst ensuring that the aged care workforce is not dissuaded from continuing to work in the sector, or that potential employees are not deterred from applying to work in the sector.

3.187The committee also recognises that some inquiry participants called for the bill’s regulatory provisions of aged care digital providers to be strengthened. The committee encourages the Department to monitor the digital provider sector and the appropriateness of these regulation measures.

3.188Finally, the committee heard concerns from providers about the bill’s whistleblower protections and the categories of people to whom disclosures qualifying for protection can be made. However, the committee acknowledges that these categories were intentionally designed to be broad to ensure the largest possible scope of protection.

Aged Care Rules

3.189The committee heard evidence regarding the visibility and release of the Aged Care Rules that are referenced throughout the bill’s provisions. The committee understands the deep interest that aged care stakeholders have in the Rules but notes evidence from the Department that they cannot be finalised until the bill is passed. It is critical that this bill be passed without delay so that the Rules can be finalised and released for the public to view.

3.190The committee also notes the evidence regarding the Rules prescribing the consent model for restrictive practices. The committee encourages the government to give consideration to the authorisation model, as suggested by some inquiry participants, or to introduce enhanced reporting mechanisms in relation to consent for restrictive practices. The committee also urges the government to ensure that thorough consultation is undertaken on the development of the rules in the lead-up to the bill’s commencement.

3.191The committee further acknowledges the calls from submitters and witnesses for the Aged Care Quality Standards to include matters related to workforce, including elements such as number of staff or training requirements. The committee encourages the government to continue to address these matters within the Aged Care Quality Standards, or in other Rules, where appropriate.

Supporting providers to transition to the new Act

3.192The proposed changes introduced in the bill are substantial to ensure older people are put back at the centre of aged care. As such, the committee acknowledges concerns from inquiry participants, mainly providers, regarding the level of support that they will receive from the government to transition to the new requirements under the bill by 1 July 2025. Specific concerns were raised regarding compliance, education and ICT capability.

3.193The committee acknowledges the government’s stated commitment to supporting the sector to effectively transition to the new requirements, so that providers can meet their obligations, as identified by both the Aged Care Quality and Safety Commission and the Department. The committee urges the government to ensure that providers are provided with adequate communication and support during the transition process.

3.194The committee strongly encourages the government to make educational materials and guidance resources available to the sector as early as possible to ensure that providers have adequate time to prepare their staff and systems to successfully implement the bill’s provisions.

Urgent and timely reform

3.195The committee is of the view that the bill meaningfully responds to the findings of the Aged Care Royal Commission, and acknowledges that the majority of witnesses, including advocates, providers and aged care experts, strongly support the bill’s passage. Many explicitly stated that the bill must be passed by the end of the year to ensure a timely transition process.

3.196The committee strongly encourages the government to consider the issues raised by witnesses and submitters detailed above in any further development of the bill and the Aged Care Rules, but, notwithstanding this, believes that the bill must be passed urgently.

3.197Older Australians and their families simply cannot wait any longer for a better and safer system. The bill will ensure that older people are placed at the centre of aged care for current and future generations to come.

3.198The committee recommends that the bill be passed.

Senator Marielle Smith

Chair

Footnotes

[1]See, for example, UnitingCare Australia, Submission 3, p. 4; Palliative Care Australia, Submission 7, p. 2; Federation of Ethnic Communities’ Councils of Australia, Submission 8, Meals on Wheels Australia, Submission 9, [p. 1]; Anglicare Australia, Submission 13, p. 4; Carers NSW, Submission 15, [p. 1]; Bolton Clarke, Submission 29, p. 3; Hireup, Submission 30, p. 1; Aged and Community Care Providers Association, Submission 31, p. 1; Carnegie Catalyst, Submission 48, [p. 1]; Relationships Australia, Submission 49, [p. 1]; Anglicare Sydney, Submission 53, [p. 1]; Uniting NSW.ACT, Submission 58, [p. 1]; Rosemary, Private capacity, Committee Hansard, 16 October 2024, p. 16; Val, Private capacity, Committee Hansard, 16 October 2024, p. 18; Gwenda, Private capacity, Committee Hansard, 14 October 2024, p. 32.

[2]Royal Commission into Aged Care Quality and Safety, Final Report - Care, Dignity and Respect: Volume 2, March 2021, p. 188.

[3]Aged Care Taskforce, Final Report of the Aged Care Taskforce, March 2024, p. 4.

[4]Aged Care Taskforce, Final Report of the Aged Care Taskforce, March 2024, p. 4.

[5]Aged Care Taskforce, Final Report of the Aged Care Taskforce, March 2024, p. 12.

[6]Aged Care Taskforce, Final Report of the Aged Care Taskforce, March 2024, p. 12.

[7]Mr Michael Lye, Deputy Secretary Ageing and Aged Care, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 31.

[8]Royal Commission into Aged Care Quality and Safety, Final Report - Care, Dignity and Respect: Volume 1, March 2021, p. 769.

[9]Aged Care Taskforce, Final Report of the Aged Care Taskforce, March 2024, p. 20.

[10]National Seniors Australia, Submission 10, p. 4.

[11]Australian Council of Social Services, Submission 12, p. 2.

[12]The Hon. Anika Wells, Minister for Aged Care and Minister for Sport, House of Representatives Hansard, 12 September 2024, p. 70.

[13]Department of Health and Aged Care, Government Response to Aged Care Taskforce, 12 September 2024, p. 1.

[14]Ms Nikki Meredith, Chief Executive Officer, Matthew Flinders Care Services, Committee Hansard, 14 October 2024, p. 10.

[15]Ms Melissa Argent, Chief Executive Officer, Rockpool Residential Aged Care, Committee Hansard, 11 October 2024, p. 7.

[16]Boneham Aged Care Services Inc., Submission 28, p. 2.

[17]Ms Tracey Burton, Chief Executive Officer and Executive Director, Uniting NSW/ACT, Committee Hansard, 16 October 2024, p. 2.

[18]Mrs Stephanie Buckland, Chief Executive Officer, Amana Living, Committee Hansard, 18 October 2024, p. 9.

[19]Uniting Care Australia, Submission 3, p. 6.

[20]Department of Health and Aged Care, answer to written question on notice regarding support available to providers and workers, 3 October 2024 (received 24 October 2024).

[21]Department of Health and Aged Care, answer to written question on notice regarding support available to providers and workers, 3 October 2024 (received 24 October 2024).

[22]Department of Health and Aged Care, answer to written question on notice regarding the impact of Bill on regional and rural providers, 3 October 2024 (received 24 October 2024).

[23]Department of Health and Aged Care, answer to written question on notice regarding the impact of Bill on regional and rural providers, 3 October 2024 (received 24 October 2024).

[24]Ms Susan Trainor, Assistant Secretary, Funding Operations and Analysis Branch, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 29.

[25]Ms Susan Trainor, Assistant Secretary, Funding Operations and Analysis Branch, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 29.

[26]Mr Trevor Johnson, Chief Executive Officer, Eyre Peninsula Old Folks Home Inc., Committee Hansard, 14 October 2024, p. 15.

[27]Boneham Aged Care Services Inc., Submission 28, p. 4.

[28]Mr Tom Symondson, Chief Executive Officer, Aged and Community Care Providers Association, Committee Hansard, 17 October 2024, p. 15.

[29]Dr Nick Hartland, Special Advisor, Home and Residential Division, Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 16.

[30]Ms Susan Trainor, Assistant Secretary, Funding Operations and Analysis Branch, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 32.

[31]Ms Susan Trainor, Assistant Secretary, Funding Operations and Analysis Branch, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 32.

[32]Ms Michelle Schupelius, Operations Manager, Edenfield Family Care, Committee Hansard, 14 October 2024, p. 3.

[33]Mr Trevor Johnson, Chief Executive Officer, Eyre Peninsula Old Folks Home Inc., Committee Hansard, 14 October 2024, p. 9.

[34]See, for example, Ms Melissa Argent, Chief Executive Officer, Rockpool Residential Aged Care, Committee Hansard, 11 October 2024, p. 5; Mr Trevor Johnson, Chief Executive Officer, Eyre Peninsula Old Folks Home Inc., Committee Hansard, 14 October 2024, p. 10.

[35]Mr Christopher Stewart, Chief Executive Officer, Helping Hands Aged Care Inc., Committee Hansard, 14 October 2024, p. 2.

[36]Ms Nikki Meredith, Chief Executive Officer, Matthew Flinders Care Services, Committee Hansard, 14 October 2024, p. 11.

[37]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024, p. 2.

[38]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024, p. 2.

[39]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024, pp 2–3.

[40]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024, p. 3.

[41]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024, p. 18.

[42]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024, p. 23.

[43]Mr Michael Lye, Deputy Secretary Ageing and Aged Care, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 23.

[44]Dr Nick Hartland, Special Advisor, Home and Residential Division, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 32.

[45]Department of Health and Aged Care, Support at Home program handbook, 17 October 2024, p.33.

[46]Department of Health and Aged Care, Support at Home program handbook, 17 October 2024, p.33.

[47]Mr Douglass Doherty, Chief Executive Officer, Family Based Care Tasmania, Committee Hansard, 4 October 2024, p. 24.

[48]Mr Douglass Doherty, Chief Executive Officer, Family Based Care Tasmania, Committee Hansard, 4 October 2024, p. 24.

[49]Mr Jim Paterson, Senior Manager, Advocacy Tasmania, Committee Hansard, 4 October 2024, p. 16.

[50]Mr Nick Morgan, Assistant Secretary, Support at Home Reform Branch, Home and Residential Division Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 4.

[51]Mr Nick Morgan, Assistant Secretary, Support at Home Reform Branch, Home and Residential Division Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 4.

[52]Mr Nick Morgan, Assistant Secretary, Support at Home Reform Branch, Home and Residential Division Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 4.

[53]National Seniors Australia, Submission 10, p. 9.

[54]Explanatory Memorandum, p. 106.

[55]Department of Health and Aged Care, Features of the new Support at Home program | Australian Government Department of Health and Aged Care, last updated 17 October 2024.

[56]Department of Health and Aged Care, Features of the new Support at Home program | Australian Government Department of Health and Aged Care, last updated 17 October 2024.

[57]Department of Health and Aged Care, Features of the new Support at Home program | Australian Government Department of Health and Aged Care, last updated 17 October 2024.

[58]Helping Hand Aged Care Inc., Submission 11, p. 5.

[59]Anglicare Australia, Submission 13, p. 8.

[60]Ms Caitlin McMorrow, NDIS and Aged Care Funding Specialist Lead, Vision Australia, Committee Hansard, 24 October 2024, p. 7.

[61]Ms Caitlin McMorrow, NDIS and Aged Care Funding Specialist Lead, Vision Australia, Committee Hansard, 24 October 2024, p. 7.

[62]Mr Christopher Stewart, Chief Executive Officer, Helping Hands Aged Care Inc., Committee Hansard, 14 October 2024, p. 2.

[63]Mr Nick Morgan, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 26.

[64]Mr Nick Morgan, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 21 October 2024, pp. 18–19.

[65]Mr Nick Morgan, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 21 October 2024, pp. 18–19.

[66]Mr Nick Morgan, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 21 October 2024, pp. 18–19.

[67]Professor Michael Pervan, Chief Executive Officer, Independent Health and Aged Care Pricing Authority, Committee Hansard, 3 October 2024, p. 19.

[68]Professor Michael Pervan, Chief Executive Officer, Independent Health and Aged Care Pricing Authority, Committee Hansard, 3 October 2024, p. 20.

[69]Independent Health and Aged Care Pricing Authority, In-home aged care | IHACPA, 2024.

[70]Independent Health and Aged Care Pricing Authority, In-home aged care | IHACPA, 2024.

[71]Mr Ian Yates AM, Acting Inspector-General of Aged Care, Office of the Inspector-General of Aged Care, Committee Hansard, 3 October 2024, p. 10.

[72]Ms Thea Connolly, First Assistant Secretary, Home and Residential Division, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 27.

[73]Mr Michael Lye, Deputy Secretary Ageing and Aged Care, Department of Health and Ageing, Committee Hansard, 3 October 2024, p. 32.

[74]Dr Nick Hartland, Special Advisor, Home and Residential Division, Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 14.

[75]Office of the Inspector-General of Aged Care (OIGAC), Submission 1, p. 3.

[76]OIGAC, Submission 1, p. 3.

[77]OIGAC, Submission 1, p. 3.

[78]See, for example, Australian Human Rights Commission, Submission 21, [p. 1]; Human Rights Act Campaign, Submission 22, [p. 4]; Aged Rights Advocacy Service (SA), Submission 25, p. 3; Elder Abuse Action Australia, Submission 27, p. 5; Relationships Australia, Submission 49, p. 16; Dr Peter Freckleton, Dr Peter Freckleton, Submission 128, p. 2; Professor Wendy Lacey FAAL, Submission 167, p. 7.

[79]Explanatory Memorandum, p. 82.

[80]Peter F, Private capacity, Committee Hansard, 14 October 2024, p. 20.

[81]Human Rights Act Campaign, Submission 22, [p. 4].

[82]OIGAC, Submission 1, p. 3.

[83]Ms Mel Metz, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 30.

[84]Explanatory Memorandum, p. 82.

[85]OIGAC, Submission 1, p. 3.

[86]Occupational Therapy Australia, Submission 32, p. 2.

[87]Ms Mel Metz, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 30.

[88]Ms Patricia Sparrow, Chief Executive officer, Council on the Ageing Australia, Committee Hansard, 17 October 2024, p. 38; Gwenda, Committee Hansard, 14 October 2024, p. 32.

[89]Department of Health and Aged Care, answer to written question on notice regarding the Complaints Commissioner under the Aged Care Bill, (received 24 October 2024).

[90]Department of Health and Aged Care, answer to written question on notice regarding First Nations Aged Care Commissioner, (received 22 October 2024).

[91]Summer Foundation, Submission 37, p. 3.

[92]National Aboriginal Community Controlled Health Organisation, Submission 93, p. 7.

[93]Explanatory Memorandum, p. 30.

[94]See, for example, UnitingCare Australia, Submission 3, p. 7; Anglicare Australia, Submission 13, p. 5; Young People In Nursing Homes National Alliance, Submission 17, p. 3; Elder Abuse Action Australia, Submission 27, p. 4; Neurological Alliance Australia, Submission 34, pp. 2–3; Australian Nursing and Midwifery Federation, Submission 40, p. 7; Emerge Australia, Submission 42, [p. 2]; Australian Autism Alliance, Submission 69, p. 12; COTA Australia, Submission 112, p. 7.

[95]Neurological Alliance Australia, Submission 34, [p. 3].

[96]Ms Leanne Groombridge, Chief Executive Officer, Advocacy Tasmania, Committee Hansard, 4 October 2024, p. 12.

[97]See, for example, Aged and Community Care Providers Association, Submission 31, p. 1; Anglicare Sydney, Submission 53, p. 2; Uniting NSW.ACT, Submission 58, p. 3; The Hon Chris Picton MP, Minister for Health and Wellbeing, Government of South Australia, Submission 70, [p. 1].

[98]UnitingCare Australia, Submission 3, p. 7.

[99]Aged and Community Care Providers Association, Submission 31, p. 1.

[100]Mr Trevor Johnson, Chief Executive Officer, Eyre Peninsula Old Folks Home Inc., Committee Hansard, 14 October 2024, p. 16.

[101]The Hon. Anika Wells, Minister for Aged Care and Minister for Sport, House of Representatives Hansard, 12 September 2024, p. 67.

[102]See, for example, Hireup, Submission 30, p. 1; Health Services Union, Submission 101, p. 13.

[103]Hireup, Submission 30, p. 1.

[104]Mr Peter Willis, General Manager, Attendant Care, Hireup, Committee Hansard, 17 October 2024, p.12.

[105]Mr Peter Willis, General Manager, Attendant Care, Hireup, Committee Hansard, 17 October 2024, p.12.

[106]Health Services Union, Submission 101, p. 13.

[107]Department of Health and Aged Care, answer to written question on notice regarding regulation of online platforms under the Aged Care Bill 2024 (received 25 October 2024).

[108]Explanatory Memorandum, p. 4.

[109]Commonwealth Ombudsman, Submission 4, p. 6; Human Rights Law Centre, Transparency International Australia, and the School of Governmental and International Relations - Griffith University, Submission 23, p. 4.

[110]Commonwealth Ombudsman, Submission 4, p. 6.

[111]Commonwealth Ombudsman, Submission 4, p. 6.

[112]Aged Care Bill 2024, subpara. 547(a)(i) to (vii).

[113]See, for example, Meals on Wheels Australia, Submission 9, p. 3; Anglicare Australia, Submission 13, p. 5; Aged and Community Care Providers Association, Submission 31, p. 5; HammondCare, Submission 57, p. 8; Baptist Care Australia, Submission 118, p. 5.

[114]Ms Silvia Alberti, Chief Operating Officer, Baptcare Ltd, Committee Hansard, 4 October 2024, p. 2.

[115]Aged and Community Care Providers Association, Submission 31, p. 5.

[116]Anglicare Australia, Submission 13, p. 5; Aged and Community Care Providers Association, Submission 31, p. 5.

[117]Ms Mel Metz, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 6.

[118]Ms Lauren Hutchins, Assistant Secretary, New South Wales, ACT and Queensland Branch, Health Services Union, Committee Hansard, 17 October 2024, p. 3.

[119]Ms Mel Metz, Assistant Secretary, Legislative Reform Branch, Department of Health and Aged Care, Committee Hansard, 21 October 2024, pp. 6–7.

[120]See, for example, UnitingCare Australia, Submission 3, p. 4; National Seniors Australia, Submission 10, p. 1; Hireup, Submission 30, p. 7; Aged & Community Care Providers Association, Submission 31, p. 2; Older Persons Advocacy Network, Submission 36, p. 5; Relationships Australia, Submission 49, p. 7; Post Polio Victoria, Submission 50, p. 1; Australian Podiatry Association, Submission 55, p. 7.

[121]OIGAC, Submission 1, p. 8.

[122]Mr Peter Willcocks, Submission 122, p. 23.

[123]National Seniors Australia, Submission 10, pp. 4 and 10.

[124]Mr Michael Lye, Deputy Secretary, Ageing and Aged Care, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 23.

[125]Mr Michael Lye, Deputy Secretary, Ageing and Aged Care, Department of Health and Aged Care, Committee Hansard, 3 October 2024, p. 23.

[126]UnitingCare Australia, Submission 3, p. 8.

[127]Explanatory Memorandum, p. 2.

[128]UnitingCare Australia, Submission 3, p. 8.

[129]Older Persons Advocacy Network, Submission 36, p. 5.

[130]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024.

[131]Department of Health and Aged Care, Additional information in relation to public hearing appearance on 3 October 2024 – Chapter 4, Summary of proposed rules, additional information received 10 October 2024, p. 2.

[132]Aged Care Justice, Aged Care Reform Now, Carers’ Circle and Independence Matters, Submission 26, p. 5.

[133]Older Persons Advocacy Network, Submission 36, p. 33.

[134]Aged Care Justice, Aged Care Reform Now, Carers’ Circle and Independence Matters, Submission 26, p. 5.

[135]Queensland Public Advocate, Submission 5, p. 2.

[136]Relationships Australia, Submission 49, p. 3.

[137]Dementia Australia, Submission 86, p. 10.

[138]Aged Care Quality and Safety Commission, Submission 2, p. 7; Aged Care Quality and Safety Commission, Strengthened Quality Standards, www.agedcarequality.gov.au/providers/quality-standards/strengthened-quality-standards (accessed 17 October 2024).

[139]Explanatory Memorandum, p. 69.

[140]Explanatory Memorandum, p. 69.

[141]Royal Commission into Aged Care Quality and Safety, Final Report – List of recommendations, March 2021, p. 223.

[142]Explanatory Memorandum, p. 69.

[143]Australian College of Nursing, Submission 78, p. 2.

[144]Mrs Magriet Raxworthy, Chief Executive Officer, Dietitians Australia, Committee Hansard, 11 October 2024, p. 11.

[145]Mrs Magriet Raxworthy, Chief Executive Officer, Dietitians Australia, Committee Hansard, 11 October 2024, p. 11.

[146]Australian Nursing and Midwifery Federation, Submission 40, p. 4.

[147]Aged Care Justice, Aged Care Reform Now, Carers' Circle and Independence Matters, Submission 26, p. 3.

[148]See for example, UnitingCare Australia, Submission 3, pp. 8 and 14; Federation of Ethnic Communities’ Councils of Australia, Submission 8, p. 8; Helping Hand Aged Care Inc., Submission 11, p. 6; Anglicare Australia, Submission 13, pp. 9–10; Aged and Community Care Providers Association, Submission 31, pp. 3–4; Osteopathy Australia, Submission 33, p. 6; Silverchain, Submission 38, pp. 5–6; Uniting NSW.ACT, Submission 58, p. 7.

[149]Anglicare Australia, Submission 13, p. 8.

[150]Ms Jude Emmer, Chief Executive Officer, Wesley Mission Queensland, Committee Hansard, 11 October 2024, p. 32.

[151]Silverchain, Submission 38, p. 5.

[152]RSL LifeCare, Submission 59, p. 1.

[153]Aged Care Quality and Safety Commission, Submission 2, p. 4.

[154]Mr Michael Lye, Deputy Secretary, Ageing and Aged Care, Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 6.

[155]Mr Greg Pugh, First Assistant Secretary, Reform Implementation Division, Ageing and Aged Care Group, Department of Health and Aged Care, Committee Hansard, 21 October 2024, p. 6.

[156]Aged Care Bill 2024, subcl. 25(4).

[157]Aged Care Bill 2024, subcl. 25(4).

[158]LGBTIQ+ Health Australia, Submission 20, p. 1.

[159]LGBTIQ+ Health Australia, Submission 20, p. 1.

[160]LGBTIQ+ Health Australia, Submission 20, p. 1.

[161]Explanatory Memorandum, p. 321.

[162]Aged Care Workforce Remote Accord, Submission 52, [p. 2].

[163]Aged Care Workforce Remote Accord, Submission 52, [p. 2].

[164]Aged Care Workforce Remote Accord, Submission 52, [p. 2].

[165]Business Council of Australia, Submission 92, p. 22.

[166]Business Council of Australia, Submission 92, p. 22.

[167]Ms Lauren Hutchins, Assistant Secretary, New South Wales, ACT and Queensland Branch, Health Services Union, Committee Hansard, 17 October 2024, p. 4.

[168]Ms Lauren Hutchins, Assistant Secretary, New South Wales, ACT and Queensland Branch, Health Services Union, Committee Hansard, 17 October 2024, p. 4.

[169]Ms Annie Butler, Federal Secretary, Australian Nursing and Midwifery Federation, Committee Hansard, 17 October 2024, p. 5.

[170]Explanatory Memorandum, p. 104.

[171]Explanatory Memorandum, p. 104.

[172]Young People In Nursing Homes National Alliance, Submission 17, p. 4.

[173]Young People In Nursing Homes National Alliance, Submission 17, p. 4.

[174]Young People In Nursing Homes National Alliance, Submission 17, p. 11.

[175]Department of Health and Aged Care, answer to written question on notice regarding exceptions for younger people to access aged care services, (received 22 October 2024).

[176]Mr James Atkinson, Chief Executive Officer, Aboriginal Community Elders Service, Committee Hansard, 24 October 2024, p. 15.

[177]Ms Melisa Coveney, Principal Solicitor, Darwin Community Legal Service, Committee Hansard, 24 October 2024, p. 19.