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Aged and healthcare silos create a life-and-death tragedy

Toby Hall - SMH
August 2020

There’s no shortage of analysis about the horrific COVID-19 crisis in Victoria’s aged care facilities and what it reveals about a system near collapse. But while the finger pointers slug it out in the news and opinion pages, we’ve largely ignored an issue that has been laid bare by this disaster and will remain long after the emergency has passed if we don’t do something about it.

It’s the terrible way our health and aged care systems work together. Or don't.

St Vincent’s Health is one of the few organisations in Australia that provides both hospitals and aged care services. That gives us a front-row seat to how badly these sectors interact and how every player has a hand in contributing to the mess.

On the primary care front, many GPs are reluctant to continue caring for a patient once they enter aged care. This can be devastating for the patient because these are usually relationships that have been built up over years, sometimes decades.

Aged care centres then struggle to forge strong and long-lasting relationships with local GPs, which can make continuity of care for residents a serious challenge. As for on-call or after-hours GP services, they often have little understanding of aged care, and their quality varies dramatically.

I’ve been told of an after-hours GP service that provided two summaries of care to two separate residents at one of our facilities that was an exact copy with just a change of name – which speaks volumes.

As for hospitals, their relationship with aged care centres is often characterised by poor communication and little or no recognition of their specific challenges.

Hospitals regularly discharge aged care residents back to their facility with next to no notice or consultation. Most aged care facilities would have multiple shocking stories of "surprise discharges": of elderly residents returning home from the hospital in a taxi, at all hours of the day and night, having been discharged with no notice or information about their treatment. As a result, the aged care facility is in the dark about the resident’s treatment or follow-up care plan.

And as for aged care sites, preventing unnecessary hospital presentations and admissions should be one of their important responsibilities – especially in the era of COVID-19 – but you wouldn’t know it from the number of times we see residents in emergency departments for minor ailments.

It’s common to find frail, elderly people in EDs, uprooted from their residence, waiting for hours to be seen about a minor issue, which could have been far more effectively treated at home. And for what? To be prescribed a course of antibiotics.

Of course, the incapacity of many aged care providers to offer appropriate standards of palliative, dementia and mental healthcare has also been well covered by the Royal Commission into Aged Care Quality and Safety.

And above all, governments and health and aged care authorities just haven’t shown the leadership nor kept up with the required funding or reforms.

COVID has revealed how poorly the aged and health care sectors work together. Siloed. Ignorant of each other’s challenges. Protecting their own interests.

So what are we going to do about it?

Part of the solution comes down to the obvious: more funding to provide more specialist healthcare roles in aged care centres – such as nurse practitioners – and better-qualified staff who can more effectively take part in pain, wound and continence management, and detect and manage serious concerns such as dementia and palliative care.

But in a post-COVID environment where health and aged care funding will be under extreme stress, we’re going to need solutions that break down the silos but don’t break the bank.

One of the positive healthcare lessons we’ve learnt from the pandemic is the power and efficiency of virtual care and telehealth.

We’re never going to be able to station a full-time geriatrician at every single aged care facility. But we should be trialling new virtual healthcare centres, staffed by a range of relevant specialities, which can provide expert care and advice specifically for aged care residents and their carers.

There's a precedent for this. The West Australian government runs an Emergency Telehealth Service which successfully provides specialist emergency medical support, 24 hours a day, to almost 80 small hospitals scattered throughout the state.

Initiatives like this would bring highly qualified care right into the heart of aged care facilities while reducing unnecessary ED visits and boosting the health of elderly residents, all while making financial sense.

The poor interaction between our health and aged care systems has been rudely exposed by the pandemic. While we deal with the emergency at hand, we must also start thinking of the long-term changes we have to make so aged care residents start receiving the healthcare they deserve.

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