‘Missed opportunity’ for GPs and in-home aged care reform

Jolyon Attwooll

8/12/2022 4:51:02 PM

General practice is pivotal for the health and wellbeing of in-home aged care patients, the RACGP President has said.

GP and older patient at home
GPs have raised the difficulties of providing face-to-face in-home aged care

Changes to in-home aged care should recognise the central role GPs play in the wellbeing of older people, the college has told the Department of Health and Aged Care (DoH).
The recommendations were contained in an RACGP submission sent this month in response to a DoH discussion paper designed to highlight the key issues for in-home aged care reform.
The discussion paper identifies a number of shortcomings with the current system, including program complexity, as well as waiting times to access funding for home care packages.
However, the document does not refer to the role of GPs and general practice.
RACGP President Dr Nicole Higgins called the proposed model outlined in the document ‘a missed opportunity to support better integrated GP-led care for older people’.
While expressing the college’s backing for reforms ‘that streamline access to appropriate services’, Dr Higgins emphasised the central role of GPs.
‘The fact that neither general practice nor GPs are mentioned once in the discussion paper on the proposed model is a significant oversight,’ she said.
‘GPs are key to improving the health and wellbeing of older people … [who] have much greater need for care.
‘They require general practice services at a significantly higher rate than other age groups and are more likely to go to hospital.’
It is a trend that Professor Dimity Pond, a GP with a special interest in aged care, clearly recognises. She reports a ‘rapidly growing’ number of older people requiring higher levels of care.
‘Many elderly people have multiple chronic diseases and need care for each of those – including medications, monitoring of side effects, encouragement of appropriate diet, exercise and other factors to reduce the impact of the disease,’ she told newsGP.
‘These [patients] absolutely need a GP to manage them, unless the task is delegated to multiple different subspecialists, which most older people don’t want and is very expensive to the system.’
According to Professor Pond, home visits are often not viable for GPs, but what happens in the house can have an enormous impact clinically.
While noting that GPs do not need to be directly involved in the social support care, she says it is important they are kept up to date. Knowing whether a patient is keeping up with medications, or is eating and exercising appropriately, are key considerations, Professor Pond believes – and she says that information can often be difficult to obtain. 
‘[GPs] really do need to know what is going on in terms of support services, so that they don’t assume the diet is good when it is mainly bread and jam [for example],’ she said.
‘Also, the physical and mental conditions that contribute to social care needs are regularly reviewed by the GP and they need to know who to notify when additional support is required – [such as] when dementia worsens.’
Professor Pond recognises significant gaps in the current system.
‘It needs to be collaborative care between us and the homecare services, but it isn’t at the moment,’ she said.
‘People would do much, much better if we knew what each other were doing, and were able to make suggestions.
‘[For example], the homecare people might know that the person is having falls [and] … it could be because of the medication they’re on. We could fix that if we knew it was happening.
‘It works both ways. We could get valuable information from them, and they could get valuable information from us, and all of that would help the patient.’
Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, agrees that the ageing population means in-home aged care will become ‘a much more significant issue’ over the coming years.
Like Professor Pond, he is aware of the declining scope for GPs to offer home visits and describes the current model for face-to-face care as ‘absolutely inadequate’.
‘Current MBS home visit items simply are not feasible,’ he said.
The authors of the DoH discussion paper identified other issues with the existing system.
‘Aged care assessments need to do a better job of accurately identifying the needs of older Australians, and programs need to better direct funding to address needs,’ they wrote.
They also cited a recent study of 2500 people with similar needs using in-home care, and highlight that they ‘may be receiving very different levels of service’.
On a specific note for general practice, Dr Marinucci references technical challenges, including getting remote access to clinical systems. He also cites physical issues such as using clinical equipment including ear toileting machines, ECGs and spirometers.
In addition, he points to the removal of longer telehealth items, which he says is ‘unfairly impacting more complex patients’ who are often older.
His concern is also raised in the submission by the RACGP President, who called for the re-introduction of patient rebates for phone consultations lasting longer than 20 minutes.
She wrote that the removal of the rebates ‘likely had a disproportionate effect on older people who cannot leave their house to access services’.
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Dr Ian   9/12/2022 2:47:36 PM

Nurses Cooks Cleaners and Security personnel are as central to aged care as are General Practitioners Ambulance Paramedics Physical Therapists Speech Pathologists Pharmacists and Geriatricians and many others .
As for remuneration even now after the Callous Medicare Rebate Halt there is something in long consultations precision care plans and case conferences and pharmacy review .
But when it is Corporate it can be unsatisfactory.
In the USA some salaried pharmacists have to do medication reviews on a for profit assembly line pace .
Dementia Training Australia have great educational modules which help understanding agitation aggression apathy and wandering and designing protocols to lessen their severity .
And there are educational modules on medications which are potentially inappropriate (Beers Criteria ) revised every few years .
There is a fact which is that we need medical schools to increase training opportunities for all health care workers and improve humane care .