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11 Oct 2019

BY AMA VICE PRESIDENT DR CHRIS ZAPPALA

In my first article as the Chair of the Medical Practice Committee (MPC), I would like to focus on the recent developments in aged care. Aged care is one of MPC’s primary areas of focus.

Unfortunately, the situation in the aged care sector has been deteriorating for several years. The current effort by the Government and others to restore a high level of care and dignified living for older Australians need not however wait for the Royal Commission report. There is much we can implement without delay.

The Royal Commission into Aged Care Quality and Safety was established by the Government in October 2018, with a mandate to look into the quality and safety of services provided to older Australians. This includes the systemic failures in the provision of services, mistreatment or abuse, dementia care, the role of government and aged care service providers in ensuring high quality care, and the sustainability of aged care into the future.

The Royal Commission has so far held a number of hearings, as well as community forums, attempting to obtain insights from the community, recipients of aged care services and their family members, aged care service providers and the Department of Health officials on the workings of the sector. The AMA has made extensive written and verbal submissions to the Commission.

The Commission has thus far uncovered systemic failures in care provision for our oldest and most vulnerable people. As the Commission’s hearings were unfolding, additional evidence of those failures came from some of the cases reported by the media. Firstly, there was the case of closure of a residential facility in the Gold Coast, the Earl Heaven Retirement Village, which left 70 people stranded. A number of the frailest residents required transfer to hospital because no other suitable accommodation could be found.

Few could forget the cases of maggots being found in the ear and a head wound of elderly residents in BUPA facilities in Queensland and New South Wales, respectively. It is an astonishing disgrace that 43 non-compliance notices have been issued by the Aged Care Quality and Safety Commission to one of the largest for profit providers in Australia.

When I reflect on the experience of my grandmother in a residential aged care facility, I recall spartan nursing resources causing difficulties with medication timing and accuracy. The built facility was however very lovely and peaceful. 

For a long time the AMA has been arguing that the health and aged care systems in Australia have been suffering from a lack of government support and resources, to the detriment of our older Australians. A growing ageing population with multiple complex chronic diseases, coupled with reductions in funding for aged care, have led to the almost daily failures we are witnessing as practitioners. This, when combined with low Medicare rebates for GPs working in residential facilities, and the declining number of registered nurses in aged care has conspired with other forces to allow standards of care to diminish and basic compassion be lost in some circumstances. Beginning down this pathway of inquiry few would have predicted the true extent of the isolation and travails being borne by some senior Australians. The Commission was clearly overdue.

Along with our advocacy activities, AMA has been engaging with the Australian Aged Care Quality and Safety Commission, working on the development of the new clinical governance in aged care resources. We have argued for improved communication between doctors and residential aged care facility (RACF) staff, and for establishment of protocols with visiting practitioners around clinical responsibility. We have also strongly argued for greater accountability of aged care providers for failures in clinical care provision.

AMA has also been engaging with the Department of Health and Chief Medical Officer Professor Brendan Murphy around the appropriate use of restraints in aged care. The AMA maintains that the prime purpose of restraint should be the safety, wellbeing and dignity of the patient – it should only be prescribed when the potential risk of the patient not being restrained is higher than the harm caused by the restraint itself. It is our view that use of restraints in aged care could be further minimised by having sufficient numbers of trained staff available, and by having registered nurses available in RACFs 24/7. Introduction of a mandated (adequately-trained) staff-resident ratio would be an appropriate step in that direction. To that end, the AMA welcomed the recent announcement by the Queensland Government.

The MPC held its face to face meeting on 21 September. Significant portion of that meeting was dedicated to devising our future policy in aged care, including our future engagement with the Aged Care Quality and Safety Commission, optimisation of use of medicines for older Australians and the AMA’s position on innovation needed in aged care to ensure its future sustainability and safety. Dr Melanie Wroth, Chief Clinical Advisor of the Aged Care Quality and Safety Commission presented at the meeting and discussed the Commission’s work and expectation of future AMA involvement in the Commission’s processes. It is worth noting that AMA was one of the strongest advocates for introduction of the Chief Clinical Advisor role with the Commission.  Strong, enlightened medical leadership is a pre-requisite for any significant program of change in healthcare, as will hopefully occur in this sector.

As hard as the situation in aged care may be at the moment, I look forward to chairing the MPC through these challenging times for the sector. The AMA and the Medical Practice Committee have an important role to play in ensuring that the rights of older Australians are respected and that they enjoy the standard of living and compassionate clinical care they deserve. Older Australians have the right to age with dignity and to have services they require tailored to their needs. This also involves care provided by a general practitioner being appropriately remunerated to attend RACF. In my next column I look forward to talking to you about the other work stemming from our recent meeting, including AHPRA engagement, medication changes and of course the MBS Review.

 


Published: 11 Oct 2019