The Aged Care Royal Commission into Quality and Safety held a hearing in Canberra from December 9 to 13.
The Canberra hearing inquired into interfaces between the aged care system and the health care system, including both Commonwealth and state/territory programs. The Commission examined whether older people, particularly those living in residential aged care facilities, are able to access the health services they need as they age. And the answer was, NO.
A need to improve access to primary health care services in aged care – palliative care
During the five days of hearings, the Commission looked at the need to improve access and consistency in primary health care services, particularly access to general practitioners (GPs), nurse practitioners and primary care nurses for older people in residential aged care.
Evidence presented suggested a need identified for improved data collection, communication and planning in relation to the health needs of older people accessing aged care services. A number of witnesses spoke of the problems their loved ones faced when they were dying. One witness spoke of how her mother’s aged care facility was not equipped for dying with staff becoming upset about her mother’s decision to refuse treatment. Her mother was no longer eating and rarely conscious but staff would suggest getting her up for a shower.
Several palliative care nurses told the Commission that these experiences were not unusual despite the fact that aged care residents should be able to get care that matches their symptoms..
The evidence has prompted calls for proper access to state or territory funded palliative care services for people living in residential aged care.
Dementia and pain
The Commission also heard disturbing evidence that many people with dementia – which is a large proportion of aged care residents – are suffering pain unnecessarily. There is a misconception that people with dementia don’t feel pain, and therefore are reluctant to use opioids. One expert told the Commission that there are many tools available to help in assessing dementia patients and no excuse for not caring for them properly.
Aged care facilities becoming more like hospitals but not
Ahead of the hearing the chief executive of the Councils on the Ageing (COTA) Australia, Ian Yates, said access to such services among older Australians was poor and subject to some of the ageism that the royal commission had already called out. He said older Australians in aged care were often left with a rushed visit from a visiting GP. Many doctors are calling for a new model that doesn’t treat health care for aged care residents as an afterthought.
“Once a person is in residential aged care, there is a strong tendency across Australia for them to not have the same kind of access to the health system as they used to when they were living in the community,” he said.
Evidence from some witnesses showed the link between poor health care and insufficient staffing.
“My experience has been that unless people who can’t speak on their own behalf have someone to advocate for them, then they’ll be overlooked and basically neglected because of insufficient staffing levels,” one family member of an aged care resident said.
There were many stories during the hearing of poor care. In one case a man who complained of chest pain – and that he was having a heart attack – was dismissed by staff. They told him it was “all in his head” and even told his family there was no point in calling an ambulance for him as it wouldn’t come. His family took him to an outside GP where it was confirmed he was having a heart attack.
“He shouldn’t have to beg staff for it or he shouldn’t have to wait until we’re able to advocate for him,” his daughter said on the issue of her father asking for Panadol.
Advance care directives in the spotlight
An Advance Care Directive is a document people can create to give instructions to people about their care when they are no longer able to communicate.
As the Royal Commission heard, the details that are important because they can impact the way death unfolds in an aged care facility.
The evidence presented shows the importance of people getting expert help in preparing an appropriate and effective Advance Care Directive. Discussing the directive with family is important so that they can ensure an aged care facility and health practitioners are honouring the directive. (For more information you can read my blog – “How the dying can ensure their wishes are met – Advance Care Directives”.)
The Royal Commission into Aged Care will take a break over Christmas. More hearings will be scheduled for 2020.