GPs should be able to directly refer older patients for basic home support without putting them through the full My Aged Care assessment process, under a CHSP Alliance proposal aimed at restoring primary care to the front end of aged care.
GPs and other health professionals should be able to “socially prescribe” Commonwealth Home Support Program (CHSP) services directly to older Australians who need relatively simple help such as meals, transport or allied health care, the CHSP Alliance says.
The Alliance has developed a draft proposal for an alternative pathway into the CHSP that would allow GPs and potentially other health professionals to directly approve access to low-level services.
The existing single assessment system would remain available, but older people approaching their GP or a CHSP service directly would not necessarily have to undergo a full aged care assessment before receiving support.
CHSP Alliance chair Paul Sadler told the CHSP national conference in Melbourne on Monday that the current system was effectively subjecting people with relatively simple needs to an unnecessarily intensive assessment process.
“If you’re approaching the meals service direct, or you’re going through your local GP, the position that we’re putting forward is that you should be able to get a tick and automatically get access to that CHSP service,” he said.
“We’re effectively over-assessing people for their needs for care at this low entry level.”
Mr Sadler said faster access to low-level support was also important to the CHSP’s preventive role.
“We know that if you get quick access to low-level services, that’s going to make all the difference.”
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‘GPs really are the linchpin’
Geriatrician Professor Susan Kurrle backed a greater role for primary care, arguing aged care assessment had become increasingly disconnected from the health professionals already caring for older Australians.
“GPs really are the linchpin in the healthcare of older people,” she said.
“About 90% of older people see their GPs at least once a year.”
Professor Kurrle contrasted the current system with the multidisciplinary aged care assessment teams she worked in from the late 1980s, which included geriatricians, social workers, nurses, physiotherapists and occupational therapists.
Those teams were embedded in local health services, had strong links with GPs and other community services, and predominantly assessed older people in their homes.
“What have we got now? We’ve got separate … assessment services, completely isolated from health services and GPs,” Professor Kurrle said.
She cited the case of an 81-year-old patient with end-stage prostate cancer who was assessed by a service that did not have access to his health records.
The patient had undergone radiotherapy and chemotherapy but did not tell the assessor because he assumed they already knew about his medical history.
“The assessment service was not linked to health, did not have access to health records, and did not pick up that this 81-year-old man had end-stage prostate cancer,” Professor Kurrle said.
GPs also frequently did not know their patients were undergoing aged care assessments and therefore did not have the opportunity to provide relevant clinical information, she said.
‘That’s all this patient needs’
Professor Kurrle said existing primary healthcare services should instead be used as part of the assessment pathway for low-level aged care.
“We need to use our primary health care sector,” she said.
“That could be your GP, it could be nursing, could be pharmacy, it could be physio, psychology. It’s a whole lot of different primary health care services.
“They’re out there. They’re looking after older people now.”
Professor Kurrle said GPs had previously been able to refer patients directly to services such as Meals on Wheels.
She recalled a colleague in Batemans Bay becoming angry after trying to make such a referral and discovering he could no longer do so.
“He said, ‘That’s all this patient needs, so they have to go through My Aged Care?’ And I said, ‘Yes’.”
Some GPs would require additional training to take a greater role in CHSP access, Professor Kurrle said, but others had been making these decisions for years “and are very annoyed now that they can’t do it anymore”.
Getting in before frailty takes hold
Professor Kurrle said giving GPs a social prescribing role could also help address frailty before an older person’s needs became substantially greater.
She said the gap between Australians’ health span and lifespan had increased from about 10 years to 12 years.
“We haven’t compressed morbidity. We’ve expanded it because of frailty and dementia,” she said.
Identifying people when they were pre-frail could allow GPs to prescribe interventions including exercise, exercise physiology, physiotherapy, and dietetic support.
But social prescribing could also connect patients with non-clinical supports, including Men’s Sheds, social activities and community transport.
“We [need to] get in at that early level,” Professor Kurrle said.
Those interventions were things GPs, practice nurses and practice managers could readily help arrange, she said.
“I think [that] is really, really important for our future.”
