Senior Counsel Assisting Peter Gray QC (pictured above) has stated the Royal Commission will be exploring the idea that the role of aged care providers needs to be “expanded and clarified” to ensure older Australians in residential care receive the health care they are entitled to – and ensure there are “no gaps” in responsibilities for providing that care – in a 25-minute opening address.
Describing the interface as “a patchwork quilt that does not join together particularly well”, Mr Gray said the ‘gaps’ in the interface between aged care and the health care system are not a new problem with multiple reports raising concerns as late as 2018.
The Senior Counsel also noted that over 500 of the 7,219 public submissions to the Royal Commission have concerned access to health care services in residential care.
The Royal Commission’s own analysis backed this concern with “some startling results”, namely:
- In 2016-17, almost 70% of permanent aged care residents didn’t see a medical specialist, compared to 40% living in the community;
- 8% of permanent residents didn’t see a GP in 2016-17; and
- 46% of GPs don’t deliver services to aged care residents.
“Over five years to 2017-18, the increase in the number of residents with high needs in the ACFI Complex Health Care domain exceeded the increase in general practitioner services for aged care residents,” Mr Gray said. “This leaves us with no confidence that the data demonstrated sufficient access to GPs for people in residential care” (again, the lack of data letting down older Australians).
There is more data available on the number of residents who accessed specialists – but again, this number is low, with just 32% seeing a specialist in 2016-17 compared to 74% of people in a Home Care Package.
“There is very poor access to specialists, and this needs urgent attention,” Mr Gray concluded.
The Senior Counsel outlined five themes to be explored this week:
- Improving access and integration with primary health care (i.e. GPs, nurse practitioners and primary care nurses);
- Improving access and integration with secondary and tertiary services (i.e. geriatricians, psycho-geriatricians, palliative care specialists, and rehabilitation specialists) (mental health services will be considered separately next year);
- Improving access and integration with palliative care services;
- Improving the transfer of older people in residential aged care to and from hospital; and
- Improving the mechanisms and processes between the aged care and health care systems.
Mr Gray also flagged that the Commission will be testing a number of propositions throughout the week, including:
- State and Territory hospital outreach services should deliver services into residential care and people’s homes with recurrent funding available for multi-disciplinary teams of RNs, nurse practitioners and other specialists (i.e. geriatric ‘flying squads’)
- Access to publicly funded secondary health care for older Australians receiving aged care be expanded nationally to provide consistent access with any future funding agreement to contain an acknowledgement by the States and Territories that aged care recipients have the right to access services
- Blended payment arrangements should be implemented in which a GP practice taking on an aged care resident would receive an annual payment based in the recipient’s health needs, fee-for-service payments for complex or out of hours attendances, and performance payments based on factors such as immunisation rates or diabetes management planning; and
- The role of aged care providers be expanded and clarified to support people to receive the health care they need, and ensure there are no gaps in responsibilities for providing that care.
“To this end, in one of our propositions we suggest that individual care recipients should have a care coordinator with the skills and training to ensure that the health care needs of individual older people are identified and addressed,” Mr Gray said. “We will test whether this role should be undertaken by care providers organisations, or whether it should be filled by independent services.”
Finally, Mr Gray said they would also look at whether the legislation that sets out the care and services that aged care providers offer needs to be clarified.
“It is not clear what obligations to ‘provide assistance’ in obtaining health practitioner services or access to specialised therapy services or rehabilitation services mean in practice.”
In short, the Royal Commission is looking at providers’ level of responsibility in ensuring residents receive health care services – with the implication that further regulation could be imposed to force facilities to be accountable.
Will the witnesses this week support this idea – or will they see it as simply more ‘bureaucratic spaghetti’ for providers?
