Crisis in Aged Care Looming

More than one in three doctors plan to cut back on or completely end their visits to patients in residential aged care facilities (RACFs) over the next two years, citing a lack of suitably trained and experienced nurses, and inadequate Medicare patient rebates, a new survey has found.

The fourth AMA Aged Care Survey of more than 600 GPs, consultant physicians, and palliative care and geriatrician specialists, carried out in November 2017, found that doctors are making more visits to RACFs than they were two years ago, and are spending more time with patients.

But more than 35 per cent of the doctors surveyed reported that they plan to not take on new patients, reduce the number of visits, or stop completely, over the next two years, and the proportion of respondents visiting RACFs has dropped by 13.55 per cent since 2015.

Doctors are also concerned about the trend to replace registered and enrolled nurses with personal care attendants, who are not appropriately trained to deal with the health issues older people face.

AMA President, Dr Tony Bartone, a GP who also makes RACF visits in Melbourne, said that the survey raised worrying concerns about the issues involved in providing medical care to older Australians.

“We are making this report public because now, more than ever, we need action in aged care,” Dr Bartone said.

“Australia is facing an ageing population, with more chronic, complex medical conditions than ever before. The current aged care workforce does not have the capability, capacity, and connectedness to adequately meet the needs of older people.

“People living in RACFs must have timely access to medical practitioners to avoid adverse health events, unnecessary hospitalisations, and associated costs to the health system.

“The AMA members surveyed said that having sufficient numbers of experienced nurses available is their top priority, with two-thirds (65.92 per cent) rating this as urgent or extremely urgent.

“Almost 85 per cent said that a nurse, with most specifying a registered nurse, is the level of expertise required to conduct a professionally responsible handover for their patient’s care.

“Many doctors reported that there is sometimes no nurse available for doctors to carry out a clinical handover, and no nurse available to administer medicines after-hours.

“This poses serious risks to the health of patients living in RACFs.

“The survey also found that doctors must be adequately compensated for spending time away from their surgery, with 57 per cent rating this as urgent or extremely urgent.

“More than four in five doctors who had decreased their visits to RACFs over the past five years said that increasing, unpaid non-contact time was the reason for their decision.

“Fewer than 10 per cent of respondents said that the Medicare Benefits Schedule (MBS) rebate for visiting patients in RACFs was adequate enough to compensate for non-contact time, including locating the patient, filling in scripts and paperwork, talking to relatives, renewing scripts over the telephone, and telephone calls to staff while in their surgery.

“When the GP Aged Care Access Incentive (ACAI) payment ends in April next year, more GPs may abandon visiting RACFs.

“Add to that the fact that almost half (47.11 per cent) of all monthly visits to RACFs are from doctors aged 61 years and older, with less than 4 per cent of monthly visits from doctors aged under 40, there could be a workforce crisis as the older doctors retire.

“The AMA has communicated these concerns directly to the Aged Care Workforce Strategy Taskforce, which was due to report to the Minister for Aged Care, Ken Wyatt, by June 30 2018.

“There must be adequate funding to ensure that Australia’s ageing population has access to quality medical care through a quality aged care workforce. This must be an urgent priority,” Dr Bartone said.

The AMA Aged Care Survey Report can be read at https://ama.com.au/article/2017-ama-aged-care-survey

Background

• The number of older Australians aged 65+ is projected to be 8.7 million by 2056 – 22 per cent of the population.
• In 2009-10, more than half of RACF residents (53 per cent) had dementia. This proportion is estimated to grow, with projections reaching up to 1.1 million people with dementia by 2056.
• The AMA Aged Care Survey has been conducted in 2008, 2012, 2015, and 2017.
• The survey was emailed to 5,599 AMA members who identify as general practitioners (GPs), consultant physicians, and palliative and geriatrician specialists in early November 2017.
• Members were given three weeks to complete the survey, and 608 responded to all or part of the survey.

25 July 2018

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