Professor Christopher Poulos (pictured above) – who has been the Head of Research & Aged Care Clinical Services for HammondCare since 2016 – has directed the Commission’s attention towards the ‘bureaucratic spaghetti’ that prevents people in residential care from accessing the transitional aged care or the recently introduced Short-Term Restorative Care (STRC) programs – and those on home care packages from using the STRC – despite more intensive hospital rehabilitation being unsuited to many older people.
For just under an hour, Prof Poulos said he would in principle support Senior Counsel Assisting Richard Knowles’ proposition that the National Health Reform Agreement include performance targets for States and territories to ensure that those aged over 65, particularly those in residential care, should receive an “appropriate” period of subacute rehabilitation with funding tied to that requirement.
However, the Professor – who still maintains his own community practice mainly seeing older people with cognitive impairments – maintained a better option could be tying the funding to the resident or patient – in effect, Consumer-Directed Care (CDC) for rehabilitation services.
“Clearly, the detail needs to be worked out, but whether it’s done at that high level of reform or whether there are other models that could ensure that people do actually get access to those rehabilitation services on the ground – if the funding somehow sat with the person and they were able to use that funding to access the program,” he stated.
Like Mr Jenkin, Prof Poulos also pushed for an overhaul of the Medical Benefits Schedule (MBS), labelling it “not fit for purpose” for people with complex needs.
He pointed out that the MBS items for conducting comprehensive assessments – which all require the specialists to spend a minimum of 60 minutes with the patient and vary greatly in their remuneration –are only directed towards geriatricians, not other specialists.
“Other physicians who might do similar comprehensive assessments with patients with similar degrees of complexity and, as mentioned, develop similar comprehensive plans that require lots of liaison and follow-up post the event don’t have those – don’t have similar items, and I’m suggesting that they should have access to those items for doing similar types of work,” he said.
The Professor says new item numbers need to be designed and different payment models introduced to encourage specialists to offer services to both a large pool of residents as well as continue to visit those they may have seen before their admission to residential care.
However, he acknowledged the issue of attracting specialists into residential care is not solely a financial one.
“I think that for many specialists it’s probably quite a foreign thing for them that they may not have ever visited a residential aged care home in a professional capacity at all,” he stated.
His solution is to introduce students to residential care when they do their medical training as well as looking at exposing trainees in specialty programs to facilities.
“I think that it would be entirely appropriate for the colleges to be charged with the responsibility of developing these models, working with the specialty societies and coming up with some solutions to the problem. I don’t recall – I don’t know if – if the government or – has – whether the colleges are actually 30 being specifically approached to say you need to be – we would like you to work on these models and, you know, the carrot could well be that we’re going to try and fix the MBS to make them work as well or look at other funding models such as specialist outreach programs and how those could be funded.”
Commissioner Lynelle Briggs could see the attraction of medical colleges leading the charge.
“And it seems to be the way you could more affectively systematise these arrangements rather than the current ad hoc arrangements which often just work on the basis of personal connections; a doctor has moved in, or a doctor appears at the local, for example, MBS service as we saw in Rylstone and says, ‘I’m here, I’ve just bought a hobby farm”’, she commented.
Prof Poulos concluded that residential care is the ideal place to provide rehabilitation to older people because it is cost effective, offers 24/7 personal care support during recovery and provides better care, particularly for people with dementia – and Australia should be looking to other models.
“I don’t think that we’ve looked at the rehabilitation-in-the-nursing-home model at all in Australia because we – because of various conflicts between Commonwealth and State, and no one’s really got together to design some models,” he said. “I understand that that’s a model that is in place in the Netherlands, and, of course, in the United States they have a model called – where people go to skilled-nursing facility, which is not too dissimilar to a residential aged care home in my understanding, but – where people can get access to this – may be not as intense, but – a bit-more-prolonged program.”
The Royal Commission will need to cut the red tape first though.
