In its current form, the RACGP says the support at home program does not recognise the expertise of specialist GPs.
Requiring providers to communicate with a patient’s usual GP, recognising the validity of a GP dementia diagnosis, and providing more funding for home visits are all ways in which the RACGP believes the Support at Home program could become less of a “missed opportunity”.
The college released its submission to the senate standing committee on community affairs inquiry into the Support at Home program on Monday, as public hearings into the matter continue.
Administered by the Department of Health, Disability and Ageing, SaH replaced the home care packages program and the short-term restorative care program at the end of last year.
Controversially, the program uses the algorithm-based Integrated Assessment Tool to assess patients for all aged care services.
The IAT was only updated to allow a human clinical assessor to override its results around two months ago.
The RACGP had a different bone to pick with the tool.
“The most significant barrier to receiving appropriate support is when patients have dementia,” the college wrote.
“The IAT currently does not recognise a GP’s diagnosis of dementia as a ‘confirmed diagnosis’.
“Currently, in many cases these patients need to receive additional, unnecessary referral to neurologists or geriatricians to receive a ‘confirmed diagnosis’.
“When patients suffer delays in receiving home support for their dementia they risk further deterioration to the point that by the time care is received it is already insufficient.
“…GPs have often been supporting the patient since their earliest dementia symptoms and will be well aware of the patient’s condition.
“Requiring them to receive an additional diagnosis from a geriatrician or neurologist adds significant cost and delays to the patient due the waiting lists and high out of pocket costs associated with non-GP specialists.”
It also alleged that the IAT “routinely underestimates” the level of support needed by a patient with dementia, and that patients with cognitive conditions were not receiving enough funding to meet their needs.
The college issued a litany of recommendations, including that the IAT be adjusted to recognise the validity of a GP dementia diagnosis.
It also called for more funding to help GPs deliver home visits to patients with impaired mobility accessing end-of-life care.
Because Medicare rebates tend to only recognise the time spent physically with a patient, the RACGP said older patients who have complex care needs and significant administrative requirements were at a disadvantage.
“While additional incentives exist for patients in residential aged care, there is no additional funding to support the care of older people in home care,” the college wrote.
“Where GPs can support patients to stay well in the community, it reduces the likelihood that their heath will deteriorate to the point that they need to enter residential aged care.”
Speaking at the senate inquiry on Monday, Peter*, who had polio as a child, described his lived experience as a Support at Home participant.
“At home, I can open the front door remotely and exit for a bit of sun or a chat with a neighbour,” he said.
“I can turn on heaters and lights, shower seated, dry and dress myself, even pressure socks, and do up my belt.
“I’m a lucky bugger in a home built for me.
“However, a life in narrow hallways of three-point turns, reverse wheelchair opening doors … 2.7 by 3 metre bedrooms … and microwave meals is a very different life to mine.
“More so, hospital or resi care would have me lay in bed, glaring [at] unreconcilable aged care statements.
“Support at Home, inflationary pricing, cuts to care hours, unaffordable gaps in co-payments, baffling governments, administrative overkill.
“Older people go without, opt out, and die without … 4812 older Australians approved Support at Home died before receiving a single service in 24-25.
“That is a person promised support, abandoned to hope, dying every two hours.”
Peter said there were “well-intentioned people still in denial”.
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“Amazingly, senior public servants and their ministers still refuse to acknowledge that the current aged care system is doing massive harm,” he said.
Retired registered nurse and hospital manager Jenn*, who is an informal carer for her husband with dementia, urged the committee to recommend that the IAT be redesigned to support clinical judgment, not to replace it.
“[To allow] these professionals to use their clinical training and insight to add immense and irreplaceable value to the care ecosystem,” she said.
“To remember that behind every wait list is an older Australian and their carers and family struggling to hold the line.
“Older Australians are dying waiting for a system that values their dignity and practically supports their carers.”
Jenn said it was time to stop the administrative delays and excess governance that were “contributing to real harm”.
“I implore the committee to champion these urgent reforms before more time and more lives are lost to a system that is failing its fundamental purpose,” she said.
“Older Australians with complex needs like my husband do not have the luxury of time for gradual systemic transitions or software updates.
“They are declining. They are dying while waiting for a system that affords them basic human dignity, agency and affordable care.”
Retired educator Deb* who has a background in disability and learning support, told the hearing about her first-hand experience of the aged care system through caring for four older people.
“These four experiences taught me a single confronting lesson: that the system doesn’t fail in a uniform way – it fails differently for every person who needs it, and when it fails, the cost can be measured in lives,” she said.
“There remains a significant unsupported gap between the moment an older person first needs help and the moment it is delivered.”
Deb said the aged care system should be designed to be accessible, understandable, and supportive for all, but the online Support at Home guide was 44 pages and 8500 words longs.
“For many Australians, that represents close to an hour of online reading before even interpreting the unfamiliar terminology and considering decisions,” she said.
“The difficulty is not simply the length of the document. It’s the combined burden of the acronyms, the financial tables, the eligibility rules, percentage ranges, the multiple pathways, and references to still more documents and links.
“So not until page 14 is there something simple, which is a flow diagram. But I want you to remember we’ve, you’ve probably already lost our audience by page 14, and let’s remember that most of them don’t have a device.”
Hearings continue this week.
* Only first names of people with lived experience were given at the hearing.
