A group of Registered Nurse facility managers at three Not For Profit operators has warned the Commissioners the limited time of specialists – and the perception that residents don’t need specialist care – makes it difficult for them to provide specialist health care in their facilities.
In a 75-minute session, Counsel Assisting Brooke Hutchins questioned the panel: Fiona Lysaught (pictured above), the Director of Care Services at two of The Whiddon Group’s aged care facilities in Narrabri, NSW; Judith Gardner (pictured below), the Clinical Care Manager at Churches of Christ Care’ Buckingham Gardens Aged Care Service in Brisbane; and Thomas Woodage (pictured further below), a Facility Manager at Baptistcare WA in Perth – around a variety of issues including GP visits, shared electronic systems, outreach services, hospital discharges and telehealth.
The facility managers had clearly been chosen to provide a perspective of how practical some of the propositions being weighed up by the Royal Commission around the interface between aged care and health services – and they didn’t hold back on what they thought.
“Have you ever asked any of these specialists to attend at your facility?” Ms Hutchins asked.
“Now and again I try,” replied Ms Gardner – who has 30 years’ experience and supports 50 residents under a cottage-style model at her facility. “The answer will always be no.”
“Are you ever given a reason?” Ms Hutchins followed up.
“These specialists, they don’t have to give reasons,” Ms Gardner answered, to laughter from the room.
Commissioner Lynelle Briggs clearly felt specialists should be making themselves available however.
“Clearly specialists can earn a lot more money by seeing people in their rooms or hospitals or so on, and so they don’t feel a financial need to attend. But the question is, is there a moral and ethical need to attend?” she enquired. “Would it be appropriate for the various colleges associated with the various types of surgery practices and possibly also the AMA to be invited to consider these possibilities?
Mr Woodage agreed, but Ms Gardner and Ms Lysaught were more skeptical.
“I don’t think that you could make them do it,” Ms Gardner said slowly. “I think, you know, if we could have a list of people who are prepared to come, that would be really helpful because then we could, you know, make appointments with those particular people. I mean, I understand that they’re busy, they’re busy people. They have a lot of people that they have to see. And yet, we work in aged care and the requirement for all the - the perception that people in aged care don’t need that type of specialist input is out there.”
Ms Lysaught – who manages 98 beds over Whiddon’s two facilities in Narrabri and has 40 years’ experience as an RN – added that her residents are used to travelling long distances so they don’t expect to see specialists insitu.
The panel also disagreed that GPs should be taking on a care coordinator role for residents, arguing that aged care staff are already fulfilling this role.
“They are not with these people like we are for eight hours a – or, you know, for a longer period,” Ms Lysaught said. “We have the time. We have the knowledge. We are their – we start off as advocates for them. We know these people.”
This obviously went against what Commissioner Briggs has heard from other witnesses and community forum speakers.
“We’ve heard a lot of evidence about how there might be a single care coordinator for an entire aged care facility and they’ve got Buckley’s chance of knowing the people and working with them and delivering the care,” she commented. “So, insights that any of you might wish to give or one after the other around what is ideally the scope of practical practice in this regard?
Ms Gardner said she had this role for 60 residents in her previous job where she worked five days a week as an RN.
“Is there a finite number that they should be looking after?” she asked rhetorically. “I think it depends on how you describe their role to them, you know, what do you want the coordinator to do? Because they’re there to oversee what’s happening with the residents.”
Mr Woodage – who manages Baptistcare’s 98-bed Gracehaven home in Rockingham and 68-bed Graceford home in Byford and has 10 years’ experience as a facility manager – also made the important point that most care staff work part-time – making it hard for one person to take on a coordinator role.
Instead, he says his facilities – which also employ physiotherapists and occupational therapists as well as care and clinical staff – take on the role as a group – and this requires training.
Mr Woodage also supported further funding for such a role, noting there is currently no funding for staff to coordinate GPs and other specialists through ACFI.
The panel also questioned how helpful it would be to collect data regarding the number of ambulance callouts to aged care facilities for the Aged Care Quality and Safety Commission – the idea raised by Counsel Assisting in the previous day’s hearing.
Being located in a rural area, Ms Lysaught said smaller towns without medical staff on hand often have no choice but to call an ambulance.
“I can see that we could support the collection of data,” she stated. “I just can’t see how for my facilities, that’s going to be helpful.”
“I would question the validity of collecting that information,” Ms Gardner added. “Are we going to equate lots of ambulance calls with good care or are we going to equate lots of ambulance calls with poor care? You know, that’s really difficult.”
Mr Woodage seconded Ms Gardner’s statement, adding in WA facilities are required to transfer a resident to hospital via the emergency department for specialist treatment.
“If you’ve got a facility with a lot of clinical needs, you’re going to be sending more residents to hospital as part of our good care practice. If you’re maybe a little hospice facility with very low care needs residents with low comorbidities, you’re probably not going to be sending too many to hospital. So, it’s not only how you collect that data, how is it going to be used and is it going to be standardised as well, would be my concern.”
Like so much of the evidence, it was a session that likely raised more questions for the Commissioners than were answered.
