We need to put nurses back in nursing homes
We used to call them nursing homes. Where our grandparents, our aunts and uncles, and our mum and dad went when their needs were greater than their families could deal with.
Now we call them “residential aged care facilities”. It’s a bureaucratic term that brings dread to most of us.
Why don’t we call them nursing homes any more? Well, how can you run a nursing home with no nurses? And if what they live in is nothing like a home, why not just call them facilities?
But is this where any of us want to end our lives? Or want our parents to end their lives? We are all entitled to much more. Care that goes beyond someone to help us shower or wipe our chins.
Despite the best efforts of hardworking GPs, nurses and specialists, our broken aged care system suffers from a critical deficit of healthcare in our nursing homes, care that our older Australians deserve.
It is time we stopped viewing aged care as long-term accommodation for older people and accepted that aged care is healthcare, and put doctors back into aged care and nurses back into nursing homes.
We need this change in mindset to go with the practical changes detailed in the 148 recommendations of the royal commission into aged care quality and safety. The Australian Medical Association has been calling for some of these changes for decades.
The royal commissioners have unequivocally agreed with the AMA that we need mandated minimum staff ratios that deliver more nurses and better trained staff in aged care.
They also say we need to bring older people’s general practitioners to the centre of planning for ageing and aged care. We say, high quality medical and health care delivered by doctors must reside at the heart of the aged care system.
This is where the AMA sees the fundamental need for reform.
To achieve this we need to attract more GPs and other specialists to work in aged care by incentivising them
better. The investment in aged care will need to be complemented by adequate investment in healthcare. We want to make sure the GP is adequately supported and compensated for time away from their practice for nursing home visits.
Unfortunately, if implemented, some of the recommendations will only further deter GPs from working in aged care.
While the commissioners don’t agree on how to go forward, for us, it’s clear. It’s all about the older person’s care needs, preferences, and personal circumstances over time.
Person-centred care primarily involves GPs clinically assessing the older person’s medical needs, health and wellbeing and designing a specific and individualised care plan for them. All the better if it’s their regular GP with the long-established doctor-patient history. All other services – social, nursing, and allied health – should be based on that plan and underpin it.
Prioritising an older person’s health enables them to continue doing the things they value in life, while maintaining their independence for as long as possible. This is the sort of relationship and future of aged care we would like to see for our people and our country.
We know that our seniors prefer to age in their communities and receive care in their homes. If the government implements the relevant recommendations of the royal commission, they will be enabled to do so. As a consequence, our loved ones will be entering nursing homes older, more frail and with multiple medical conditions. This only reinforces the need for quality GP healthcare at the point of entry.
If aged care reform is correctly implemented and adequately funded, we will not only see improvements to residents’ health and wellbeing, but flow-on effects such as a reduction in the number of hospital admissions of aged care residents, most of which could have been avoided with management of the patients’ conditions by their GP.
Hospital transfers of older people are often needed and warranted. But we also know they frequently happen because the current system allows their condition to deteriorate to the point where hospital transfer is the only alternative.
The two commissioners’ approaches are still being assessed and funding models are being dissected. What we hope to see is urgent and important generational change to fix our aged care system once and for all, and bring healthcare back into aged care.
• Dr Omar Khorshid is the president of the Australian Medical Association