ROYAL COMMISSION: Issues with consistent health and aged care

On the third day of the Commission, a statement was read out by Counsel Assisting Richard Knowles SC on behalf of Hamish MacLeod, a resident living in a nursing home in Melbourne.

Mr MacLeod, 74, described his poor clinical care and medical care between his residential aged care facility, his doctor, and hospitals, including issues with document and information sharing between organisations and relevant people.

In one instance, his hospital records had been mistakenly sent to another hospital and not his residential aged care facility.

Mr MacLeod believes that a mix-up like this could have jeopardised the delivery of quality care he needed.

He also explained issues with getting doctors to visit him in his nursing home, having to walk to the closest doctors office to receive medical care and experiencing the same treatment issues from specialists.

Accessing specialist care has been an ongoing problem

On the fourth day of the Commission, a small panel was held with Professor Leonard Gray, the Director of the Centre for Health Services Research at the University of Queensland, and Professor Leon Flicker, Professor of Geriatric Medicine at the University of Western Australia.

The professors have long careers in health and aged care, have done research in geriatrician and industry practises, and were asked to attend to give their opinions about the interfaces between those two systems.

Professor Flicker explains that there have long been problems for residents in residential care settings accessing specialist care outside of their nursing home.

“The problem we have is that older people in residential care who have advanced frailty find it very hard to access routine specialist care by any other means,” says Professor Flicker.

“And so often travel is almost impossible, outpatient care is very difficult to access for them, particularly timely outpatient care. Private specialist care is extremely difficult for them to access, so older people are essentially denied specialist care in any reasonable format. 

“The only thing that’s left for them to access specialist care is through the emergency departments in major teaching hospitals where the staff there often feel aggrieved that they have to provide such care because they cannot see why it should be done in that situation.” 

Professor Gray says the hospital-led outreach services are generally quite good for providing hospital care to residents in nursing homes.

He explains that while outreach services are great for avoiding unnecessary hospitalisations, it doesn’t solve problems with continuous health support.

“In one way or another, the service has to come to [residents] to give them the equivalent access that an average citizen would be able to secure,” says Professor Gray. 

Professor Gray agreed with Counsel Assisting Knowles that the Government, State, Territory and Federal Governments, need to fund more outreach services for older people in nursing homes.

Telehealth can enhance everyday service

Professor Gray praised telehealth services and how it can enhance the clinical and health care services residents receive in aged care facilities.

“The huge advantage with telehealth is the elimination of travel and, therefore, the

travel for the residents, but also for the practitioner,” says Professor Gray.

“You sometimes need to lay hands on the resident [in person] and examine them and so forth. But once that familiarity is established, there are lots of issues that can be dealt with.”

He adds that follow up appointments become so much easier and it is also more efficient for figuring out if a type of therapy or medication is agreeing with the resident.

Professor Gray says the biggest problems with telehealth at the moment are access to background information, like medical records that are coherent, integrated and easily accessible; the availability of someone to set up a link for a telehealth appointment at the facility; and if a person has a cognitive impairment, it requires someone to be available to host the conversation with them, like an informed nursing staff.

Professor Gray also mentioned that this can also be an issue in general when doctors attend an aged care home to visit a resident and the nursing staff aren’t able to properly provide information about the resident and their medical or mental health issues.

“I would have thought that the kind of philosophical difference between an outreach hospital-type model [and moving it] into a more general model where there’s a sort of ongoing [telehealth] support; the difference is that it’s not reactive, it’s kind of proactive,” says Professor Gray. 

“We’re providing a network of capabilities and access to advice on a week-to-week basis that wouldn’t otherwise be there.”

Professor Flicker asked the Commission to set firm recommendations for the Government to increase health services for older people in aged care facilities and in higher-level community services, and that those Government services work together to produce services that help look after older people.

Multiple GPs, multiple appointments, little difference

On the last day of the Commission, Rhonda Payget provided evidence about her 85 year old mother’s experience in an aged care facility in Sydney.

She explained the ongoing issues with her mother receiving consistent health care from doctors and how trust is an important part of receiving care.

“She doesn’t really trust [the onsite doctor]. He may be a good [General Practitioner] (GP), but they just don’t have a good relationship, and her need is really to feel like someone is looking at her as a whole person; that’s her words,” says Ms Payget.

“And I think that the GP deals with specific issues as they arise. But it seems to me that there isn’t a sort of proactive care plan that’s developed by the GP as you would normally expect in the community.”

When Ms Payget looked through her Medicare records for the last three years, she saw her mother had been visited 128 times by 15 different GPs, but even with the high number of visitations, she says she has not seen it result in good care for her mother.

“I think the care is very reactive; Whatever is happening in that moment. So when GPs were called in, something has happened in that moment,” says Ms Payget.

“And my view is that, if there was more proactive and preventative attitude to care, where you had a regular care plan that was updated every six months, you may be able to pre-empt some of those issues and be able to have care more consistently provided.”

Many documents and notes from specialists and doctors about Ms Payget’s mother were never shared with each other, resulting in chronic problems not being dealt with properly for long periods of time.

Ms Payget believes a critical part of trying to have resident-centric care is to have a central care coordinator addressing issues and managing communication and transferal of information between health care and aged care.

This is the end of the Royal Commission hearings for the year and will start back up in early 2020.