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21 Feb 2019

AMA President Dr Tony Bartone has appeared before the Royal Commission into Aged Care Quality and Safety, saying exchange of information between healthcare workers in nursing homes is critical to the continuity of patient care.

A lack of nurses in residential aged care facilities is compromising the handover process, he said.

“A good handover would consist of a number of elements. It would give some factual description about what has occurred, what are the current items in play, what are the current issues around the patient’s conditions, what things might be changing, what tests might be expected to be received, and things to look out for in the ongoing period of time that you’re referring to,” Dr Bartone told the Commission.

“… That lack of opportunity to hand over, to receive the information and then to give back information after the visit is a critical part of the visit, a critical part of the care and that is of concern to our … members...

“We have many different committees, many different opportunities for our members to meet. That feedback can be through the process of normal flow of the committee work. It can be anecdotal in terms of other opportunities where members come together, but it’s continual and consistent through many different venues in our association.

“It has a number of implications. First, directly, it is subjecting the Australians in said facilities to a lesser standard of care. So, it potentially could have unintended consequences in their own direct care. But it’s also having a wider issue as well in terms of the drivers in terms of some of our members, members that have worked very hard, very long in this space, both in advocacy and directly with patients to then not continue to visit facilities because of that concern, that worry, that issue potentially around being involved in a lesser standard of care.

“If there is no one available to hand over, to have a good handover, that is – as we’ve already tried to address, it’s potentially putting that patient at a disadvantage. That does have a concern then that things might be missed, that tests might not be followed up on or not be carried out, that vital bits of information may not have been passed on in the first place.

“A good clinical handover, good clinical communication forms the foundation of, you know, the basis of good clinical care, and that – you can’t have one without complete confidence of having the other.”

Dr Bartone has pointed out that while Australia is facing an ageing population with an increase in chronic, complex medical conditions, the aged care system is currently not keeping pace with these trends.

There is a lack of integration between the health and aged care systems. Doctors feel a sense of obligation to their older patients and many enjoy the work. However, there are significant barriers GPs face when visiting aged care facilities.

One major barrier is inadequate funding for GP services through Medicare.

A lack of equipment, facilities and appropriate staff members to work with, are also significant obstacles.

“The workforce issues and the coordination of that workforce is an extremely difficult, but extremely poorly coordinated exercise … the proportionality of trained nurses has reduced as a proportion of the staff in total involved in absolute numbers,” Dr Bartone said.

“It does point to the fact that… both training and conditions… are part of that impact on the availability of the trained workforce…

“Given the increasing demand of aged care and both residents and aged care – home aged care places – that demand is going to require an even more significant impost (with the) importance on terms of training the right number. And it may be a very difficult number to achieve, especially in the short term.”

Dr Bartone, a Melbourne-based GP who makes regular patient visits to aged care facilities, said many doctors who visited nursing homes had long-standing relationships with their patients and wanted to continue caring for them medically.

But some are now contemplating decisions to end nursing home visits because of the barriers faced.

“If you are continually meeting barriers to facilitating that care, that creates anything from frustration to concern to worry,” he said.

“And ultimately, for some GPs, that worry leads them to decide that ‘no, I’m not going to continue – either I won’t take on any new patients, or I’m not going to continue to visit the facilities’.

“Both the AMA survey of doctors who visit residential aged care facilities and anecdotal feedback show that doctors are increasingly looking at cutting back on their visits or stopping altogether.”

The AMA would like to see an appropriately resourced, trained, and abundant workforce in nursing homes and both policy and practice that places a greater focus on health and medical care within the aged care system.

The aged care sector needs more registered nurses and other staff, through an aged care staffing ratio that reflects level of care need of residents and ensures 24-hour on-site registered nurse availability.

More funding, through Medicare rebates, is needed for GPs to access residential aged care facilities. And more clinical governance and strategies are required to facilitate doctor visits to the nursing homes.

In addition to more staff, especially nurses, the strategies should look to providing more clinical software interoperability, more treatment rooms, and doctor car parking, among other things.


Published: 21 Feb 2019