The Royal Commission into Aged Care Quality and Safety called for palliative care to be considered core business for aged care providers, but experts say recommendations are too piecemeal to be effective.
The commission’s final report, released earlier this week, recommends the government implement regular dementia and palliative care training as a requirement of approval for all aged care providers.
This training would be applicable to all workers who are involved in direct contact with people seeking or receiving services in the aged care system.
University of Technology Sydney Professor Meera Agar, chair of the Palliative Care Australia board and director of the UTS palliative care clinical research body IMPACCT, welcomed the recommendation but warned that the core problem will likely remain.
“Sometimes you’ve got a really good GP, a really good specialist nurse service and a facility which really recognises that the person has got uncontrolled pain,” Professor Agar told TMR.
“Everyone knows what the problem is, and the specialist nurse and the GP work out what the plan is, but you don’t have a registered nurse overnight to administer that opioid.”
Situations like this, according to Professor Agar, wouldn’t necessarily be addressed by more widespread training because the core issue is workforce shortage.
“Sometimes upskilling one part of the workforce worsens the problem, because then from a moral perspective none of those clinicians can leave the person in the aged care home overnight, because they know that person’s not going to be able to receive the care,” she said.
“Paradoxically, putting in part of the solution and not the full solution could mean hospital admissions go up.”
Although the commission does recommend a registered nurse be present for every shift, this would not come into effect until mid-2024, which Professor Agar and her colleagues say is too late, given the poor state of the industry.
The training models for GPs who want to become involved in palliative care are also unrealistic, according to Professor Agar.
“Experienced general practitioners can’t just leave their practice to go and do a six month diploma, even though they may really want to upskill and focus on aged care,” she said.
“We don’t have the training models that are fit for purpose for a GP in that interest area.
“I think that having GPs with a special interest in aged care is one of the fundamental pillars of an adequate response.”
This sentiment is shared by Monash University Professor of General Practice Leon Piterman.
“I think we should be looking at GPs with special interest to undertake advanced training in geriatric medicine, because these are the doctors who are more likely to have a cohort of patients in residential aged care that makes their working life meaningful and rewarding,” Professor Piterman told TMR.
Having more GPs with special interest, Professor Piterman said, could potentially ease pressure on geriatricians and substantially raise the quality of care.
But a major roadblock, however, is lack of funding.
Even though the final report does explicitly recommend immediate funding for education and training, this appears to be aimed at aged care providers rather than primary care.
The recommendation which calls for capitation and GP aged care accreditation also does not detail what the accreditation process involves, or how it will be funded.
Professor Piterman told TMR it was possible the government could follow the precedent set by the mental health overhaul in the mid-2000s.
“In the mid-90s, we identified mental health as being a major deficiency, but the government did a number of things to allow GPs to participate,” he said.
“That included attending sufficient courses – a minimum requirement, initially, of six hours, then 20 hours for cognitive behavioural therapy – and GPs took this on board.”
Professor Agar said GPs with a special interest in aged care were especially important for the vulnerable community of older Australians.
“We really have to facilitate and provide the specialist clinical input for the more complex scenario,” she said. “These are clients where you have to find the solution today, or else they end up in emergency.”