Delays in hospital transfers to aged care, the under-utilisation of nurse practitioners and calls to expand medicare-funded GP teleheath services are among the key issues that have been put to a senate inquiry into health policy and expenditure.
State and territory governments have voiced their concern over unnecessary hospital stays by older people who are ready to move into residential aged care.
The ACT Government told the Senate Select Committee into Health that on average 30 public hospital patients each day were waiting to access aged care services, at a cost of $1,200 per day.
Canberra Hospital had experienced an increase in “nursing home type patients” over the past two years and an increase in the average length of stay for these patients, which suggested a shortfall in aged care places, said ACT Minister for Health Katy Gallagher.
At 19 August 2014, there were 34 public hospital in-patients waiting for a bed in an aged care facility, the ACT Government told the inquiry in a submission.
The South Australian Government similarly said it was concerned about older patients, predominantly in metropolitan areas, who were staying in hospitals longer than was clinically appropriate.
It said the Commonwealth’s decision to terminate the National Partnership Agreement on Financial Assistance for Long Stay Older Patients in the Federal Budget in May presented a “direct cost shift” to the states and territories. The three-year $42 million initiative recognised the costs incurred by state and territory governments in caring for long stay older patients, the SA Government told the inquiry.
The South Australian Government said converting a large number of state-funded “nursing home type places” located in country hospitals to the Commonwealth also remained a “high priority” for the Weatherill Government.
The Queensland Government told the inquiry that successive Commonwealth Governments had failed to fund enough aged care beds, particularly in regional and rural areas.
“Hospitals in some areas are being used by people who have completed their acute and sub-acute phase of care, and are in need of aged care services,” its submission said.
“These people remain in hospital as there are no aged care services available or because they need time to organise their financial affairs in order to pay for their aged care needs.”
Giving an example, the government said that across the Cairns Hospital and Health Service region, about 60 to 70 beds were accommodating long stay older patients.
Premier Campbell Neumann told the inquiry it was in the interests of both the Commonwealth and the state to ensure the Federal Government increased access to aged care in affected communities.
He said the Commonwealth Government should also fund the total cost of Queensland Health operated aged care facilities which operated as “providers of last resort” in areas of market failure or unmet need.
In 2012-13 the total cost of state-run facilities was $191 million.
Access to medical care
The Australian Medical Association told the inquiry the aged care sector should be recognised as a component of the health system and medical care better integrated into the sector.
“As the current cohort of doctors retire, there is risk Australia will face a dramatic drop in the medical workforce available to aged care residents,” the AMA said in its submission.
“Whilst Medicare rebates are payable to all GPs who provide medical care in RACFs, the current rebates are inadequate to cover the real costs of providing services, including non face-to-face time with the patient.”
The AMA said that dedicated clinical treatment areas that were adequately equipped and private should also be incorporated into facility planning.
Aged care peak bodies ACSA and LASA both warned the inquiry against the potential negative impact of a proposed $7 co-payment on older people’s access to medical services.
ACSA said there was a great deal of concern in the aged care sector that many older Australians would not be able to afford the $7 Medicare co-payment, leading them to forgo treatment.
LASA said the process by which the co-payment would be charged and collected for those in residential care was also likely to impose a significant cost on aged care providers. There were also ethical concerns relating to a provider’s duty of care should a resident refuse to pay for a required GP visit.
Elsewhere in ACSA’s submission, the peak body called for implementation of a national program to reduce the rate of falls and subsequent hospitalisations, which it estimated cost the health system a staggering $8.4 billion per year. The Federal Government’s annual expenditure on the entire aged care system is $13 billion.
“There are many falls prevention programs across the country, and with people living longer and staying in their own homes longer, it would be good public policy to ensure falls were prevented by removing trip hazards and improving body strength,” said ACSA.
GP and NP Medicare rebates
Victorian-based provider Benetas backed growing calls for the Federal Government to fund GP telehealth consultations directly into aged care. Currently only specialist telehealth services are Medicare funded.
CEO Sandra Hills said the restricted MBS item numbers for nurse practitioners also constrained their utilisation in aged care, especially outside normal business hours when GPs were often unavailable.
“For example, a NP cannot provide Medicare rebateable services such as issuing repeat prescriptions, updating patient notes or consultations with RACF staff over the telephone,” the Benetas submission said.
The inquiry is currently conducting public hearings and is due to be completed by June 2016. A key term of reference is the integration and coordination between health and aged care.