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* Quality and continuity of care...6
* Clinical and financial outcomes... 7
* Potential savings ...9
* Home care...11
PATIENT JOURNEY EXAMPLE...12
* Investment and action...18
- General practice...19
- Nursing home staffing...24
- Technology ...27
- Home care ... 28
SUMMARY OF RECOMMENDATIONS... 29
* Appendix A: Modelled cost estimate of avoidable hospital admissions, presentations and stays from older people in the community and in nursing homes... 30
* Appendix B: Modelled cost estimate of increasing MBS rebate for GP attendances at nursing homes... 35
* Appendix C: Modelled cost estimate of everyone receiving a Home Care Package at their level of need... 36
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Older people have the same right to quality health care as any Australian. Sadly, this right is often not realised, as the
Meanwhile, health care for older people is getting more complex, not less. Increasing life expectancy and an ageing population means greater complexity of medical care in old age and increased demand for aged care and health care services now and in the future.
Reform is desperately needed because the scale of the problem is growing, but the system is already struggling. At the heart of the problem is the fact that aged care and health care operate as separate systems that enable very little or no continuity of care for older people. A detailed example of a patient journey is provided, which outlines the AMA's vision of what the patient journey should look like, juxtaposed with what currently happens.
This is all to the detriment of not only the health outcomes and quality of life of our older people, but also to public finances and the sustainability of our hospitals. The AMA estimates that if governments invested sufficiently in health and aged care, over four years (2021-22 to 2024-25),
With the scale of the problem growing and the system already struggling, the Government should use the momentum from the
What is missing from the current direction of reforms is a plan to ensure that the health care and aged care systems work together and complement each other in the future. The AMA provides this plan in the recommendations that follow, with detailed costings provided for select proposals.
Chief among these recommendations is the need to place the General Practitioner at the heart of health care in aged care. This is central to improving health outcomes and quality of life for older people and reducing avoidable hospitalisations. With the current setup of the aged care system, a GP's involvement in their patient's aged care journey is limited. The AMA calls for a number of changes going forward to incentivise, enable and resource GPs to drive proper person-centred care.
AMA members have been reporting for some time that there are insufficient nurses in nursing homes to support reliable and safe health care provision.
Person-centred care will always be hampered as long as IT systems do not permit the sharing of key health information between the health professionals involved in a patient's care. GPs, nurses and other medical practitioners, must be able to communicate and record details of medications and important health events. As a first step towards improving the situation, the AMA calls for greater clinical and aged care systems interoperability, including between My Aged Care and My Health Record.
Finally, older people are waiting far too long to receive Home Care Packages so that they can live well and live independently at home for as long as possible. There simply isn't enough funding allocated. The AMA calls for increased funding so that Home Care Packages are available to all those who need them, at the level of their need and a maximum of three months following their needs assessment.
While implementing these reforms will create savings in costly hospital transfers and unnecessarily long hospital stays, ultimately it will likely be a net cost to provide proper health care in an aged care setting. Despite that, the Government should invest in this care as a matter of principle to uphold basic human rights, and not with the expectation of breaking even. Governments will have to give thought to how this necessary care will be funded, whether it be a tax, an increase to the Medicare levy, or some other mechanism. While recognising that most recipients of aged care services will have made substantial financial contributions over many years as taxpayers, given the scale of investment needed, people who are able to make financial contributions should be asked to do so, with a safety net put in place for those who are not.
Aged care and health care must complement each other and work together for the benefit of older people and the wider community. Now is the time to design and implement adequate health and aged care policies to meet the current and future demand and needs of our older people.
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Summary of Recommendations
1. Increase Medicare rebates for nursing home attendances by GPs by 50 percent to compensate for the additional time and complexity involved in comparison to a GP consultation in their own rooms.
Detailed costing provided.
2. Introduce MBS telehealth items for phone calls between the GP, nursing home staff and relatives.
3. Introduce a Medical Access Aged Care Quality Standard for nursing homes.
4. Introduce Care Finders who work closely with GPs to coordinate both health and aged care services.
5. Introduce hospital aged care outreach teams in all local health networks, in coordination with a patient's usual GP.
6. Ensure that Aged Care Assessment remains with State health services which involve medical specialists, coordinating and collecting information from the older person's usual GP.
7. Mandate minimum staff-to-resident ratios in nursing homes.
8. Mandate 24/7 on site Registered Nurse availability in nursing homes, and according to the level of residents' needs.
9. Mandate a minimum qualification for personal care attendants that includes basic health care, and continuous training of the aged care workforce with specific funding attached for training.
10. Ensure interoperability between GP clinical and aged care software systems, including My Aged Care and My Health Record.
11. Ensure that Home Care Packages are available to all those who need them, at the level of their need and a maximum of three months following the assessment.
Detailed costing provided.
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The full report can be viewed at: https://ama.com.au/sites/default/files/2021-04/130421%20-%20Report%20-%20Putting%20health%20care%20back%20into%20aged%20care.pdf
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