The investigation must review staffing arrangements, including minimum staffing ratios, and barriers for GPs attending aged-care homes
The RACGP is calling for the Royal Commission on Aged Care to shine a spotlight on government oversight of the sector, nurse staffing levels and barriers to GP access.
The college is demanding a wide-ranging inquiry by the royal commission, probably beyond the scope imagined by Prime Minister Scott Morrison in his response to damning media coverage showing neglect and mistreatment of patients in aged care.
In a submission to the Minister for Aged Care, Ken Wyatt, the college says the inquiry should extend to the effectiveness of existing legislation to protect residents, the government’s financial arrangements and monitoring of outcomes, and the effect of corporate involvement in the aged-care sector.
On clinical governance, the RACGP says the investigation must review staffing arrangements, including minimum staffing ratios related to patient complexity, and barriers and incentives for GPs attending aged-care homes.
Earlier proposals for mandating nurse-resident ratios have been fiercely resisted by the for-profit aged-care sector.
RACGP President-elect Dr Harry Nespolon has called for “real action” from the royal commission to improve the care of vulnerable residents.
The AMA is also calling for a sharper focus on clinical care than outlined in Prime Minister Morrison’s proposals.
AMA President Dr Tony Bartone said the key problems of funding and workforce shortfalls – particularly in senior nursing staff – were well known.
“We know that, in particular, registered nurses are extremely … almost an absent breed at the moment in a number of facilities,” Dr Bartone said today on Perth radio.
The AMA says the inquiry should consider the case for a regulated registered nurse-to-resident ratio that is adequate and reflects the care needed by older people living in residential facilities.
It calls for a look at the impact of the fragmentation of the state and commonwealth health and aged-care systems, and gaps in access to care in all settings, including patients’ homes.
The commission should also investigate issues of specialist support and allied health in aged-care settings and the need for research and data concerning the care of older people, it says.
The lack of trained nurses was one of the reasons that doctors were not visiting facilities as often as they once did, especially after hours and in high-care facilities, Dr Bartone said.
Poor IT resourcing, leading to the inability to write up notes at the facility or send a script into the facility off-site, also acted as a deterrent.
“These are the little things that would just make the ability to have ongoing, continuous care in these facilities so much more resourced and so much more contemporary in nature,” he said.
In July, an AMA report indicated that more than one-third of doctors who visited aged-care facilities were cutting back because of frustration with staffing issues and poor remuneration.
As reported earlier by The Medical Republic, the AMA’s Aged Care Survey of more than 600 GPs, consultants, geriatricians and palliative care doctors found 35% planned to stop taking new patients, reduce the number of visits, or cease aged-care visits entirely in the next two years.
The survey, conducted in November 2017, also showed the proportion of respondents visiting aged-care facilities had dropped by 13.5% since the previous survey in 2015.
The RACGP submission also urges the royal commission to inquire into the sector’s use of “refundable accommodation deposits” and other financial tools.
It asks the commission to look closely at “management priorities” regarding shared decision-making informed by patient values; antimicrobial stewardship; psychoactive medication management; harmful polypharmacy; inappropriate hospitalisation; and use of urgent after-hour visits.
