‘Missed opportunity’: RACGP criticises Support at Home program

The RACGP has described a Federal Government program designed to help older people stay within their own homes as a ‘missed opportunity’ which fails to capitalise on GPs’ clinical knowledge and relationship with their patients.
 
In a submission to a Senate inquiry into the Support at Home program, the college highlights disparities between residential care funding and patients living in their own homes.
 
‘While additional incentives exist for patients in residential aged care, there is no additional funding to support the care of older people in home care,’ the submission states.
 
‘Where GPs can support patients to stay well in the community, it reduces the likelihood that their health will deteriorate to the point that they need to enter residential aged care.’
 
It notes the importance of GPs’ work in a system known for delays, saying ‘many patients are waiting far too long to receive appropriate assessment and have their needs funded’.
 
‘These delays cause harm to patients and GPs must mitigate and manage their patients while awaiting Support at Home’s assessment processes to be completed,’ the submission states.
 
The RACGP also says the existing program ‘does not recognise the expertise of GPs or accept their clinical opinions and recommendations’, leading to ‘unnecessary additional assessments’.
 
One example is a lack of recognition for GPs’ expertise in the use of the Integrated Assessment Tool (IAT), used to help decide on the level of support.
 
‘The most significant barrier to receiving appropriate support is when patients have dementia,’ the submission states.
 
‘The IAT currently does not recognise a GP’s diagnosis of dementia as a “confirmed diagnosis”.
 
‘Currently, in many cases these patients need to receive additional, unnecessary referral to neurologists or geriatricians to receive a “confirmed diagnosis”.’
 
The RACGP also highlights challenges for palliative patients in accessing funding to stay at home through the End-of-Life Pathway, with many of those eligible likely to score below 40 on the Australian-modified Karnofsky Performance Status and likely to find it hard to travel.
 
A home visit is ‘the most appropriate way to deliver this assessment’ but existing MBS funding is ‘insufficient’, according to the college.
 
Home visits have declined significantly in recent years.
 
‘While GP telehealth MBS items can assist with this somewhat, they are not a replacement for face-to-face assessments,’ the submission states.
 
It also indicates there is low awareness of hardship provisions in the program, while those who do apply find the process ‘onerous with poor success rates’.
 
Among 13 specific recommendations for amending the program, the RACGP says this should be simplified and awareness improved.
 
It also calls for GPs’ dementia diagnoses to be accepted, and for providers to be required ‘to identify and communicate with the person’s usual GP, share relevant care plans and assessment outcomes, and notify the practice of significant deterioration or material changes in services’.
 
Rapid clinical changes should trigger ‘expedited reassessment pathways’, the college says, while co-contributions should be assessed according to clinical consequence ‘as advised by the patient’s GP-led multidisciplinary care team’ rather than just service category.
 
‘For a frail older person, meals, transport, or domestic support may be critical to preventing malnutrition, falls and hospitalisation,’ the college states.
 
On a broader level, the RACGP is urging for greater funding for consultations lasting more than 20 minutes to support complex care and ‘remove structural incentives to provide shorter consultations’.
 
The Support at Home Program began on 1 November, replacing the previous Home Care Packages Program and the Short-Term Restorative Care Program.
 
A Senate inquiry was called shortly afterwards, with the Community Affairs References Committee due to hand down its report on 24 November this year.
 
Last week, RACGP President Dr Michael Wright presented to the Joint Hospital Discharge Taskforce, which is looking at delays in older patients transferring from hospital to aged care residences and NDIS placements.

Log in below to join the conversation.
 

home care palliative care Support at Home Support at Home Program