GP exodus from aged care homes

Doctors have blamed falling numbers of GPs seeing patients in nursing homes on poorly trained nurses and low Medicare rebates.

The AMA says the biggest problem for doctors when they turned up to wards at aged care centres was they often could not find registered nurses or even the residents they were meant to be seeing.

Doctors have blamed falling numbers of GPs seeing patients in nursing homes on poorly trained and overworked nursing staff, younger colleagues opting out and Medicare rebates that are too low to cover the cost of visits.

On the eve of the royal commission into aged care quality and safety, the blowtorch has turned on nursing home providers and doctors over residents who fail to receive proper care because of gaps between the two professions.

Aged Care Minister Ken Wyatt yesterday scrambled to ­announce new regulations to crack down on the overuse of physical and chemical restraints in homes, before witnesses have begun giving evidence to the commission.

The Australian revealed this week that the use of antipsychotics to dope residents who have ­dementia and mental health ­issues was at the highest level ever reported in Australia, sparking a row over the practice between ­primary health professionals and nursing homes.

“Today, I’ve asked my department to prepare regulations that will protect senior Australians within residential care,” Mr Wyatt said. “I said I want a regulation ­designed, developed for implementation. There is no going back from that point.”

 

The new regulations are expected to be released within weeks but there are no such measures on the horizon to help bridge the gap between GP care of ­patients and nursing home staff.

Australian Medical Association national president Tony Bartone, who visits nursing homes as a GP, told The Australian the biggest problem for doctors when they turned up to wards at aged care centres was they often could not find registered nurses or even the residents they were meant to be seeing. This had led to a drop in visits.

In the two years to 2017, the proportion of doctors visiting ­residential aged-care centres dropped by more than 13 per cent — which would amount to hundreds — and almost a third of the 600 GPs and physicians surveyed by the AMA said they planned to stop visiting.

“They turn up and they find someone to talk to about the clinical issues and the one thing they all say that would make a difference in them continuing or not giving up is the presence of registered nurses or access to them,” Dr Bartone said. “Doctors do this out of an obligation and sense of duty to a patient we might have seen for many years, but that can only take us so far.”

Aged-care staffing levels have been blamed for the over-use of heavy antipsychotic drugs such as Risperidone and other psychotropics such as benzodiazepines being used to turn nursing home residents into “zombies”.

Dr Bartone said some homes had not changed since the 1980s.

“They may even have gone backwards,” he said.

In the case of Kathleen Simons — who The Australian revealed on Wednesday had died from an infection in her legs that had left her tendons and a shin bone ­visible — her treating GP advised Queensland deputy coroner John Lock that he no longer saw nursing home patients. The GP conceded at the inquest that his assessment of Mrs Simons, who was a resident of Regis Canning Lodge in Caboolture, north of Brisbane, in 2015, was inadequate.

“The difficulty attracting GPs to aged-care facilities was noted by (inquest witnesses) Dr Hall and also Ms Bridges,” Mr Lock said. “Clearly this is a significant ­structural issue but of a magnitude outside the scope of an ­inquest to comment.”

In another previously unreported case, Tasmanian coroner Olivia McTaggart heard in October that 85-year-old Freda Lillian Florence Dent died of natural causes that might have been exacerbated by substandard care. Alice Frampton, her GP, changed Mrs Dent’s medication because of an upset stomach but found no nursing staff to tell.

“She stated in her report for this investigation that she did not have the opportunity to discuss her plan with any nurse at Freemasons, as there were none available while she was there,” Ms McTaggart writes in her finding.

“She noted in her report that she was particularly pressed for time due to other scheduled ­consultations.”

Despite immediately faxing her notes to the nursing staff at the Launceston Masonic Care home, they were never read. About seven hours after the check-up, Mrs Dent was dead. A registered nurse at the ­home called an ambulance about 6.30pm that day, then told the ­operator it was not urgent. A second ambulance was called two hours later, although records at the home said it was made only one hour later. Coronial medical consultant AJ Bell found that Dr Frampton should have, ideally, reported directly to nursing staff to request close observation of Mrs Dent’s vital signs.

The coroner said: “I note that Dr Frampton did take immediate steps to fax her clinical notes to Freemasons, where it might be ­assumed that the nursing staff would be sufficiently aware of the need to regularly monitor Mrs Dent and record observations. There is no indication of any consideration of Dr Frampton’s written notes by the staff.”

Dr Bartone said the Medicare rebate for an aged-care consultation would need to be raised by between 50 and 100 per cent for it “to come close to covering the cost of the visit”.

He noted that many younger doctors weren’t taking on or continuing with patients in nursing homes. “If you look at the aged-care doctors, most of them are in their 50s and 60s and very few of them are younger doctors,” he said.

“That is for a variety of reasons, including the risk involved, the nature of their work practices and the logistics. There is no doubt, if you examine beneath the surface, you will find evidence of failures at multiple points in the system.”

The break in continuity of care was also partly caused by property values. “The new facilities are all being built on the urban fringes where land is cheaper but there are not as many services,” Dr Bartone said.