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Doctors reducing visits to residential aged care facilities, report shows


Neelima Choahan


24/08/2018 4:01:56 PM

Close to a third of doctors plan to cut back or completely end their visits to patients in residential aged care facilities over the next two years.

The 2017 AMA Aged Care Survey report outlines lack of adequate remuneration as one of the main reasons doctors are reluctant to attend RACFs.
The 2017 AMA Aged Care Survey report outlines lack of adequate remuneration as one of the main reasons doctors are reluctant to attend RACFs.

Often ignored, uncared for and forgotten: Associated Professor Joel Rhee compares people who live in residential aged care facilities (RACF) to those shunned by society centuries ago.
 
‘In Biblical times, people who had leprosy were basically not seen as part of society and they were not looked after at all,’ he told newsGP.
 
‘The modern day contemporary lepers are basically people living in nursing homes. They are basically the sort of people that a lot of people don’t care about.’
 
But according to Associate Professor Rhee, GP and Chair of the RACGP Cancer and Palliative Care Specific Interests network, treating this vulnerable group is a privilege – despite its frustrations.
 
‘Looking after them is a way to serve them, and I tell students that it is a really rewarding part of being a doctor because you are actually making a difference,’ he said.

Now a recently released survey of health practitioners, including GPs and consultant physicians, shows that about in one in three doctors plans to cut back on or completely end their visits to patients in RACFs over the next two years.
 
Inadequate patient rebates that do not compensate for lost time in surgery and unpaid non-face-to-face time were cited as two of the main reasons for the decision. The survey respondents also called for more suitably trained and experienced nurses at RACFs.
 
The 2017 AMA Aged Care Survey Report, which saw 608 members respond, found that doctors are making more visits to RACFs than they were two years ago, and are spending more time with patients.
 
However, 35.67% 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. The proportion of respondents who visit RACFs has also dropped by 13.55% since 2015.
 
With respondents aged 41–60 the largest age group reporting they visit RACFs (46.94%) and contributing to the highest proportion of monthly visits (49.32%), the report also raises concerns about a future shortage of medical practitioners willing to visit these patients.
 
Respondents aged 61 and over contribute to 47.11% of monthly RACF visits, with those aged 40 or under contributing to only 3.57%.
 
Nearly half of the medical practitioners who responded said it was ‘very difficult’ to access mobile X-ray and ultrasound services and consultation with specialists.

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Associate Professor Joel Rhee believes treating people in RACFs is a privilege ‘​because you are actually making a difference’.

Associate Professor Rhee said the report highlights most of the issues that act as barriers to more doctors visiting RACFs.
 
‘I really feel many of the patients are being let down by our healthcare system, which does not understand the realities of people living in nursing homes,’ he said.
 
‘For instance, one patient had persistent unexplained vaginal bleeding. It could have been cancer and needed specialist care. The person was relatively immobile and frail and couldn’t go to an outpatient clinic or a specialist.’
 
Associate Professor Rhee said when his patient had to be sent to the emergency department for another reason, he requested the hospital to take the opportunity to investigate the bleeding, explaining in the referral letter that the patient did not have any other means of accessing specialist care due to immobility and frailty.
 
But, he said, it proved impossible.
 
‘The patient came back with nothing done about the bleeding and they said, “This person’s bleeding is not an acute issue. The emergency department is not for people for chronic problems and you should refer this patient to a public clinic”,’ Associated Professor Rhee said.
 
He said the patient, who died of other causes, was unable to visit a specialist before her death.
 
‘As a GP that has been very frustrating,’ Associate Professor Rhee said.
 
Dementia Australia Chief Executive Maree McCabe said it is concerning that more than 30% of medical practitioners are thinking about not visiting RACFs.
 
‘Many residents in residential aged care have very complex needs, not just people living with dementia. But as people get older they are more likely to be unwell,’ Ms McCabe said.
 
‘And, of course, people are going in residential aged care much later, which means they go in when they are actually quite unwell and have conditions that require medical assessment, management and intervention and treatment.
 
‘The thought that would not be available is very concerning.’

Dementia_Australia-MareeMcCabe-CEO-hero.jpgDementia Australia Chief Executive Maree McCabe believes there needs to be more of a collaboration between general practice and aged care to support the needs of people living in RACFs.
 
Ms McCabe believes there needs to be more of a collaboration between general practice and aged care to support the needs of people living in RACFs.
 
‘We know that around 60% of people in residential care have a diagnosis of dementia, but many, many more are undiagnosed and have either a cognitive impairment or dementia,’ she said.
 
‘I understand that from a GP’s perspective it is really challenging for them to manage some of the complexities in residential care, but I think there is a lot we can do to support them.’
 
Ms McCabe said Dementia Australia could also help GPs support families of the patients with dementia, allowing more time to treat other patients.
 
‘There is a lot we can do to support families and we could perhaps take some of the challenge away from the GPs,’ she said.
 
‘We have a national dementia helpline that family members can call and have a conversation with dementia experts’.’
 
Ms McCabe said there are also Medicare rebates GPs can claim if treating someone 75 years or older.
 
‘[GPs’] involvement with the resident is absolutely paramount to the wellbeing of that person,’ she said. ‘Often, GPs may have cared for this person over a long period of time and developed a relationship.
 
‘If GPs withdraw, there are going to be more and more transfers to the acute sector.’
 
When asked if the government need to look into more funding for GPs to cover the extra work required to visit RACFs, Ms McCabe said yes.
 
‘It is difficult for GPs,’ Ms McCabe said. ‘They take time away from their own practices to tend to the care need of people in residential care.
 
‘It is not just the face-to-face interaction and assessment with the resident, there is work that is going to be done after.’
 
Medicare rebates for patients aged 75 years and older

  • Brief Health Assessment (MBS Item 701) – a brief health assessment is used to undertake simple health assessments. The health assessment should take no more than 30 minutes to complete.
  • Standard Health Assessment (MBS Item 703) – a standard health assessment is used for straightforward assessments where the patient does not present with complex health issues but may require more attention than can be provided in a brief assessment. The assessment lasts more than 30 minutes but takes less than 45 minutes.
  • Long Health Assessment (MBS Item 705) – a long health assessment is used for an extensive assessment, where the patient has a range of health issues that require more in-depth consideration, and longer-term strategies for managing the patient’s health may be necessary. The assessment lasts at least 45 minutes but less than 60 minutes.
  • Prolonged Health Assessment (MBS Item 707) – a prolonged health assessment is used for a complex assessment of a patient with significant, long-term health needs that need to be managed through a comprehensive preventive health care plan. The assessment takes 60 minutes or more to complete.



aged care residential aged care facilities



Dr Nichola O'Reilly   28/08/2018 6:32:40 PM

I have been performing RACF visits for 20 years. Although I will not be ceasing my visits, they have become increasingly frustrating since the facilities became computerised. Either the computers are locked to some other user or they can take forever to log on. The time to do a ward round has increased by 30mins since computerisation. Additionally, staffing levels have decreased and finding someone to assist or who knows what has been happening can be like digging for gold. I have noticed that care levels have decreased with accreditation, not improved. The little things like clean feet and ears and well shaven men, no longer occur. This is broadly across the 7 facilities that I attend. The new style of single room nursing homes has isolated my patients and resulted in more depression and neglect. In my opinion, the change from caring for patients in their final years to keeping them alive as long as possible with the highest standard of preventative medicine has been detrimental and is costing the government a fortune.


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