For all the research and rhetoric on aged care, our frail and elderly have yet to reap any tangible benefits, writes Dr Linda Calabresi
Happy New Year. Hopefully you managed some sort of break over the summer holiday season and you’re all ready to face another year in the interesting, unpredictable and challenging world of general practice.
Aside from the issue of pill-testing at music festivals, 2019 media attention has also, so far, been focussed on the Royal Commission into Aged Care Quality, which is due to start hearing submissions in early February. No doubt it’s a pretty big deal.
In addition to inviting submissions from the general public in relation to the experience of residents of aged care, the commission has also written to almost 2000 aged care facilities asking them to supply comprehensive information on any instances of substandard care since 2013.
And while this sort of invitation may seem a little bizarre – tell us what you did wrong so we can tell you what you did wrong – the powers-that-be are promising a thorough investigation into the current deficiencies in the sector, which they say is needed to ensure future generations of elderly are protected, respected and looked after to the highest standard.
This is going to be big. The commission has already received 300 public submissions since Christmas and been forwarded another 5000 received by the federal department of health. The hearings will start in Adelaide before travelling around the country, resulting in the drafting of a preliminary report in late October.
How does all this sit with you? Does anyone feel the same ambivalence as I do? On the one hand, it is right and just that these incidences of mistreatment, neglect and, in some cases, downright abuse, be thoroughly investigated and poor practices be exposed. Victims and their families need, want and deserve this justice.
But on the other hand, playing devil’s advocate, could the time, effort and expense involved in this commission be better directed to fixing the already-known deficiencies in the current aged care sector?
There have already been a number of major investigations and assessments of aged care in Australia.
Back in early 2017, the federal health department conducted “extensive public consultation” in relation to drafting Aged Care Quality Standards. These were then developed, tested and are now (more than two years later) set to be implemented later this year.
We also had the Senate community affairs committee report, Future of Australia’s aged care sector workforce, which was released in June 2017. In addition to this, having identified staffing and training of staff as a key issue in aged care, we had the Aged Care Workforce Taskforce set up in 2017, which also conducted an investigation into the industry and reported to the federal government in June last year.
After this, an Aged Care Workforce Strategy was developed. And charged with the responsibility of overseeing the implementation of this strategy, the Aged Care Quality and Safety Commission was established and took up their posts in January this year.
All we need now is the People’s Front of Judea.
Seriously though, a hell of lot of time, money and effort has already been expended before funding has been made available for a single extra registered nurse to be employed in a nursing home or a single additional cent has been added to the Medicare rebate for GPs visiting aged care facilities.
The aged care facilities I visit are still struggling. The people working there are, for the most part dedicated and lovely, but they remain understaffed and often under-supported medically.
Just dealing with our own profession’s contribution to the bigger picture would be a start. It has been well-documented that fewer GPs are attending to patients in aged-care facilities, and the biggest drivers of this downturn are poor remuneration and frustration at the lack of suitable trained and experienced staff.
The GPs I know who do nursing home visits are always being asked if they’d like to take on more patients. And, as much as we all know it is an important part of providing good quality general practice, GP services to aged care facilities could do with some incentivising, to put it mildly.
You can hardly blame business-minded practice owners and corporates for not actively encouraging their GPs to provide these services. By the time you find a parking spot/the right ward/a staff member who knows what’s going on, and finally the patient who is not with the hairdresser/at lunch/in the loo, you’ve lost at least 30 minutes! It must be costing the government a fortune in unnecessary ambulance transfers to hospital and emergency after-hours medical services visits.
I don’t mean to imply that the problems being encountered in the aged care sector are an easy fix, or that I have any great wisdom about the best way to go about fixing them. But a number of answers are already out there – the issue seems to be implementation.
So far, it just seems there has been a lot of noise and very little music.
I’m sure the Royal Commission into Aged Care Quality will uncover new deficits, produce many headlines, and strengthen community resolve to improve the lot of many of our society’s most vulnerable.
But I just hope 2019 will be a year of at least as much action as words, and that those who need it most – our frail and elderly – will receive some tangible benefit from all this rhetoric and research.
