The Australasian College for Emergency Medicine (ACEM; the College) acknowledges the release of the Royal Commission into Aged Care Quality and Safety's final report and supports its intent of developing a new rights-based aged care system.
With the Royal Commission having highlighted many deeply disturbing issues and problems with the way older people are cared for in this country, the report must be a catalyst for improvements in the way some of our society's most vulnerable receive healthcare.
Older people deserve access to timely, affordable, appropriate and high-standard healthcare. Where feasible and appropriate, this should be delivered in the environment of their choice – be it their own home, hospital, or residential aged care facility (RACF). ACEM hopes the release of the final report, and the implementation of its recommendations, will help achieve improvements to systems which have failed too many for too long.
Member of the ACEM Geriatric Emergency Medicine Executive Dr Ellen Burkett said:
"Older people living in RACFs have increasingly complex healthcare needs and are some of the most vulnerable people in our society. This vulnerability was highlighted during COVID-19 outbreaks last year, with the impacts of widespread long-standing understaffing, under-resourcing and lack of governance of aged care facilities having devastating impacts."
"As Australia's population ages, more older people with complex health needs are presenting to hospital emergency departments (EDs). Often the ED is the most appropriate place for initial urgent clinical care to be delivered, and ACEM is committed to ensuring excellent emergency care for people from RACFs. However, between 13%-40% of all transfers from RACFs to EDs are potentially avoidable through the provision of quality clinical care in the RACF.
"Avoiding unnecessary transfer to hospital is very important, as hospitalising RACF residents can risk the further deterioration of a person's condition.
"Research also shows that RACF residents and their families would prefer to receive clinical care within the RACF where at all possible to avoid distressing and potentially risky transfers to the ED and hospital. However, it is clear that RACFs are too often not adequately resourced to deliver the level of clinical care required. RACFs require appropriate access to and funding for clinically trained staff, and resourcing to attend to people's needs without transfer to hospital.
"ACEM notes the Royal Commission's recommendation to improve transitions between RACFs and hospital, specifically hospital discharge and ambulance collection procedures, and universal adoption of digital technology and My Health Record in the aged care sector. There is a need for the integration of health records between hospitals and aged care, as well as improved communication.
"However, as was outlined in ACEM's original submission to the Royal Commission, the College would have liked to see a greater focus and more specific recommendations relating to transfer of people to hospital, as well as acknowledgment of the integral role of EDs and ED physicians in caring for older people."
ACEM President-Elect, Dr Clare Skinner, said:
"The Royal Commission heard of extremely trying circumstances, as well as time and resource pressures, facing former and current aged care facility staff. Workforce conditions and capability must be addressed."
"Recommendations for the introduction of a national registration scheme, including minimum qualification requirements, introduction of nurse to resident ratios, and ongoing professional development, may have merit in principle. However, these will require commensurate funding to avoid creating additional workforce pressures and placing older people at further risk.
"The College also supports the recommendation for the Australian Commission on Safety and Quality to set and amend safety and quality standards to improve care. ACEM would also like to see mandatory, benchmarked clinical quality measures implemented and reported on. These should also be linked to accreditation.
"ACEM has also previously advocated for funding for integrated clinical care models allowing acute healthcare needs to be met in the right place, at the right time, with personal preference taken in to account. Emergency physicians, in partnership with aged care clinicians and GPs, have led development and implementation of ED substitutive care models in a number of states that support resident choice to receive emergency care in their home environment and build capacity of clinicians across the care continuum to better care for residents with acute healthcare needs.
"We are therefore supportive of recommendations to introduce Local Hospital Network-led outreach services, increase access to mental health services and amendments to Medicare Benefit Schedule items to improve access to medical and allied health services, including telehealth. Multidisciplinary clinical care planning and the suggestion geriatricians, GPs, nurse practitioners and allied health providers work together in an integrated model are also positive initiatives.
"The College also supports the notion of health care homes for aged care, providing for registration with a GP practice then funded to provide coordinated clinical care.
"However, the Government must commit to introducing these recommendations alongside appropriate funding mechanisms, otherwise this will simply create more barriers and workforce burden for primary care providers, particularly GPs, as they seek to provide quality clinical care to residents.
"We urge the Government to commit to properly funding and implementing the recommendations in the Commission's report and look forward to hearing more details about how and when this will occur."
Background:
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
