Medical services for aged care residents treading water
By Dr Chris Moy
In February, the AMA Medical Practice Committee launched a survey seeking feedback on factors affecting the delivery of medical care in the aged care sector, particularly in residential aged care facilities (RACFs). Similar surveys were undertaken in 2012 and 2008. There were 392 responses to the survey.
On the whole, the survey results do not indicate any real change in the provision of medical care to residents since 2012.
This year, we were particularly interested in practice type. We asked respondents whether they worked solo, in small groups or partnerships, in large group or corporatised arrangements, or for one of the major corporates.
Of the respondents who attend RACFs, 74 per cent work in non-corporate arrangements (including 14 per cent in solo practices and 50 per cent in small partnerships), while 26 per cent work in large group or corporatised arrangements. This breakdown largely reflects the composition responses to the survey – 79 per cent of respondents were in non-corporate arrangements and 21 per cent worked in large group or corporatised set-ups. Given the sample size, it was difficult to conclude any bias against RACF for different practice arrangements.
Overall, respondents who currently attend RACFs indicated they are seeing more patients per visit than they were seeing in 2012 and 2008, and are accommodating more non-contact time per patient. The average reported amount of non-contact time per patient was 17.5 minutes (ranging up to 4 hours per patient).
Despite this, they are spending the same amount of time with each patient as reported in 2012, indicating that the quality of the care has not decreased. Respondent comments also reflected that many particularly enjoy visiting their RACF patients, finding the work rewarding.
To complete the picture, we also looked at the Medicare data on services provided to patients older than 65 years in RACFs, and the number of Aged Care Access Incentive (ACAI) scheme payments to GPs.
The Medicare data shows that, for the first time, there has been a slight decrease in the number of GP consultations per resident, down from 15.1 in 2012-13 to 14.5 in 2013-14.
Data for the Federal Government’s Aged Care Access Incentive (ACAI), which aims to encourage GPs to provide increased and continuing services in RACFs, shows the number of providers who qualified and received ACAI payments increased slightly (up 2 per cent) from 5310 in 2012-13 to 5435 in 2013-14. However, over the same period, the number of RACF residents increased by 10 per cent, and the ratio of GPs who qualify for ACAI has decreased from one ACAI GP for every 31 residents to one for every 34 residents.
All this suggests that the provision of medical care to RACFs has not appreciably changed since 2012.
What is clear is that we need a new strategy. We need to break down the silo mentality between medical practitioners, aged care providers, ambulance and acute services and public hospitals.
Increased collaboration between these individuals and organisations will improve the care of residents, in particular by reducing inappropriate or unwanted admissions to hospital, which are distressing for the patient and put added pressure on our already strained hospitals.
There is also a need for meaningful incentives to encourage after hours care by the usual treating GP, so they can help prevent unnecessary hospital transfers. Currently, financial disincentives and communication gaps can result in residents being transferred to hospital even when they have advanced care directives in place that indicate that they do not want to be transferred.
It is essential we engage with the aged care sector about providing the right environment in RACFs for the provision of subacute care to support and retain those that already attend RACFs, and to encourage more medical practitioners to work in the sector.
You can view the AMA 2015 Aged Care Survey at: https://ama.com.au/article/2015-ama-aged-care-survey-report
Published: 15 Jun 2015