Yet another witness to highlight the Commission’s case for good access to primary and specialist care in residential care – and for that care to be coordinated.
59-year-old Rhonda Payget (pictured above) says her 85-year-old mother’s inability to build trust with the GP at her Sydney aged care facility – and his failure to be “proactive” with her care – has had a major impact on her health and wellbeing.
In a 35-minute session, Ms Payget described how her mother had a stroke aged 76 and moved into a Sydney retirement village for five years but the lack of use of her left arm and leg and a number of falls meant she had to move into residential care in March 2016.
Saying “you don’t know what you don’t know”, Ms Payget said the family expected her mother to receive similar primary care as she did in her village where a GP had consulting rooms. Instead, Ms Payget says the GP provided by the facility hasn’t met their expectations.
There is no formal appointment process (the GP often speaks to her mother in the facility’s café) and the family isn’t able to communicate with the GP via phone – at his request.
“She doesn’t really trust him,” Ms Payget told Counsel Assisting Brooke Hutchins. “He may be a good 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. I think that the GP deals with specific issues as they arise … 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.”
To make her point, Ms Payget recently obtained her mother’s Medicare billing history which reveals her mother had 128 visits from 15 GPs in three years, 70% by her own GP and another GP and the rest by after-hours GPs.
“On the face of it, that appears to be quite a reasonable number of attendances,” Ms Hutchins noted. “Do you think that that’s resulting in good care for your mother, that number of visits?”
“I think the care is very reactive,” Ms Payget disagreed. “So, whatever is happening in that moment, so when – when GPs were called in something has happened in that moment. 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.”
The data also shows the GP has also only been involved in developing a care plan for her mother twice – Ms Payget argued new care plans and family meetings should take place more regularly.
“We have had two family meetings that have been instigated by the family, and in that period the GP, there was only – I think only one medication review for example,” she stated. “So, to me that highlights perhaps the lack of attention to looking at my mother as a whole person, which is what she wants.”
Ms Payget also pointed to an incident in October 2019 in which her mother’s podiatrist identified that her left foot was cold and discoloured but their note was not followed up by the GP and it was only a routine visit to her mother’s neurologist that resulted in her mother receiving treatment.
Ms Payget also advocated for more information about advanced care planning (the family knows her mother’s wishes but has nothing in writing and the issue has only come up when her mother has been critically ill in hospital – a common scenario) and better care coordination.
“I think there is merit in having a mandated nominated care provider because in the first instance it just gives families someone – knowledge about who you should go to because it was quite a journey for us to understand that process,” she said.
How many other families would be in a similar position?