Aged care has been run in a silo for a long time, and this is not surprising since government runs all of its programs completely separate from each other. There has been very little linkage between aged care and health care except where the Department of Veterans Affairs is concerned, or when a prescription has run out or transport is required to go to an appointment. The IT systems of aged care programs are usually accessible in-house and do not link to any other software or care providers outside aged care companies. Case managers and other staff members rarely support the GP management plans and they rarely attend case conferences.
It is amazing that aged care has been isolated from medical care even though the elderly people who reside in aged care facilities are some of the sickest and frailest Australians. They tend to need the care of general practitioners more than elderly people of the same age and sex who live at home possibly because keeping the aged at home with assistance is more beneficial than keeping them in a nursing home. With at least one chronic disease and, in some cases, disabilities, they need health care as much as they need personal care.
It is therefore very unfortunate that doctors are no longer willing to visit elderly people. The study called Australian General Practitioner Attitudes To Residential Aged Care Facility Visiting carried out by the University of Wollongong found that GPs enjoy visiting nursing homes but some of them claim that they find the visits to be frustrating because:
- Of unavoidable delays and inefficiencies connected with the work: they spend time seeking the patients, the nurses, patient notes and medication charts.
- The GP is on call pretty much all the time since patients tend to get sick any time.
- Communication is difficult if there is no remote access to the nursing home’s system in order to write notes after a phone visit.
- The work is poorly remunerated compared to the work done at the office.
- Younger GPs are either inexperienced or educationally unprepared to take care of elderly people due to lack of exposure to residential aged care facilities.
After some consultation, initiatives were put in place in 2015 to encourage GPs to visit nursing homes but up to now they still find the visits unappealing because of poor remuneration. Elderly people have complex medical problems that require the attention of GPs and specialists, but they do not have enough money from their pensions to meet these needs. GPs do not have the time, the resources and the flexibility to visit nursing homes at rates lower than they charge at their office. Yet government funding has not put these needs into consideration. As a result, doctors are not ready to take on new elderly patients and even plan to cut down on visits to nursing homes.
Finally, the Federal Government is beginning to appreciate the role that GPs play in the nursing homes and they have started to review the funding to entice them back to nursing homes. The Medicare Review Taskforce is drawing up a new remuneration plan for doctors so that they receive a flat call-out rate for visits to aged care residential facilities. But is this one-line item for billing enough? It is nowhere close. While they are at it, they should not forget home visits since Home Care needs the same attention from a GP and the planned flat rate should cover it too.
Aged care really needs to integrate and take a Primary Care Focus. Many organisations do not seem to know how social care and complex clinical needs go hand in hand. Therefore, they end up pushing their clients off to the Emergency Department or to the GP for matters that could be dealt with in-house by a nurse’s or a doctor’s visit. This is creating problems for health facilities that are already overworked. The best way forward is for doctors, nurses, allied health professionals, care givers and families to be upskilled to look after geriatric patients. In some cases the Practice Nurses should take the roles of the Case Managers in order to provide quality case management. The whole team can then take care of most health problems and reduce unnecessary visits to the emergency department.
This training effort should not be limited to government only. Organisations should take an interest and invest in training so that they can contribute to creating a whole community approach to aged care. With this comprehensive skilling, elderly people can receive the best of care from their care givers and families, with the support of well-remunerated nurses and/or doctors who visit regularly. That way the elderly people can remain healthy longer and they can enjoy their final days.
We cannot achieve high quality care for the elderly Australians if we keep aged care separate from health care. Right now, government provides integrated care for the elderly, but under separate programs and the siloed operations create barriers and inefficiencies. Consumers, who happen to be old, frail and sometimes disabled, struggle to understand where they should go for help when they have to go to two or three offices for different benefits. Their family members are usually at work or at school and they do not have the time to make many visits to many different offices.
The whole system is confusing and frustrating. We must integrate aged care into primary care if we are serious about delivering good outcomes for the elderly customers and to provide them with a good quality life. What is required is for all aged care programs to be integrated so that there is only one file for each person. In fact Health Care, Social Care and Person Centred Home Care needs to be integrated. Integrated care looks after the physical, mental and emotional wellbeing of each person. An elderly person who is suffering from chronic diseases, is disabled and is homeless should receive complete care under one program, not three different programs. If we can achieve integration, we can greatly improve the quality of care and reduce the frustration of the elderly Australians.
After integration of the programs, we can encourage all health care and aged care givers to be enablers, not barriers to integration. That means organisations, facilities and individual/private caregivers learn to work together as a team and freely share patient information so that the consumers get the best care possible. This record sharing and involvement will also promote openness and transparency and support good organisational and clinical governance. It’s a huge change that will transform Australian aged care for ever.
The GP’s Patient Centred Care model and the Client Directed care Model of My Aged care can work hand in hand. When patients are treated with dignity, and their needs and preferences are taken into account when their care plan is designed, there is improvement in quality, cost effectiveness and safety of health care. There are also improvements in patients’ and caregivers’ satisfaction. That is the thinking behind Patient Centred Care for all Australians. Consumer Directed Care in My Aged Care gives the elderly people and their families the power to determine the level of care that they require. If the two models are combined, the elderly people can receive high quality care and they will stay satisfied with their care.
We should be aware that there is a paradigm shift in healthcare generally. Patients are being encouraged to take control of their health through the provision of information that enables them to make good decisions about their health and their care. While we train care givers, we should also train consumers to take care of themselves by providing community classes and tools.
While GPs complain about the cost and frustration of home or facility visits, they should not forget that technology has advanced so well that they can take advantage of it and provide telehealth to the elderly patients. If they can use it for routine visits, they can cover many patients within a very short time and save themselves the time and cost of travel. This also needs the residential facilities to be enablers of integration by making sure that the nurses are available at specific times to work with the doctors online.
It is quite possible to improve aged care by encouraging doctors to come back to the industry through improved remuneration. We can improve aged care even more if government integrates all the programs that deal with elderly Australians. The industry itself can contribute by upskilling care givers and educating patients and becoming enablers of integration. With everyone working towards the one goal of providing high quality care for elderly Australians, we can transform the whole industry and be a shining example for the world to learn from.