Doctors, dentists and death

Experts told ACAA NSW State Congress delegates that nursing homes need to better accommodate doctors, dentists and death.


Above: AMA Vice-President, Dr Steve Hambleton.

By Stephen Easton

Residential aged care facilities must provide better access to medical and dental care, and confront the reality that palliative care is ‘core business’, delegates at the ACAA NSW State Congress heard.

In his presentation, Australian Medical Association (AMA) vice-president, Dr Steve Hambleton, explained to the audience the AMA’s position that regular and ongoing access to medical services should be part of aged care accreditation standards.

“We don’t want to impose onerous new requirements on providers, but we want to ensure medical access is guaranteed,” Dr Hambleton said. “Doctors have an essential role to play in residential aged care, but barriers to delivering medical care in [that setting] still exist.”

Dr Hambleton told of the difficulties experienced by himself and other AMA members when trying to practice in aged care facilities, including lack of patient privacy, basic or non-existent facilities for examinations and high costs due to inadequate Medicare rebates.

The AMA position is that the Medicare Benefits Scheme (MBS) rebates for doctors and practice nurses providing ongoing medical and dementia care to older people, either in aged care facilities or in the community, should be at least doubled, which the AMA estimates would cost the government $150 million.

The doctors’ group also wants providers to make facilities available for doctors, “including adequately-equipped clinical treatment areas that afford patient privacy, and information technology to enable access to medical records and better medication management”, and additional funding to “encourage and subsidise arrangements between aged care providers and doctors to ensure ongoing access to medical care in residential aged care”.

Also in the AMA’s position on residential aged care is a demand for specific MBS rebates to improve the quality of palliative care for residents, a topic expanded on by the next speaker, the President of Palliative Care Australia NSW, Peter Cleasby.

Above: President of Palliative Care NSW, Peter Cleasby.

Mr Cleasby said Australia’s death rate had reached a plateau, and that large numbers of baby boomers would reach the end of their lives in the near future, meaning all residential aged care facilities should ensure their nurses and other staff can ‘recognise dying’ and provide high-quality palliative care.

 “Ageing in place implies dying in place,” he said. “But is it achievable in all aged care contexts?”

“If the average stay in your facility is less than six months, then your facility is effectively a hospice; palliation is your core business.”

Above: Dr Peter Foltyn, Consultant Dentist to St Vincent’s Hospital, Sydney and dentist at Montefiori’s Randwick Aged Care Home.

Continuing a theme, aged care dentist Dr Peter Foltyn then warned of “a disaster in the making” in terms of oral health among the residential aged care population.

Dr Foltyn, who works in a dedicated dental surgery at Montefiori’s Randwick Aged Care Home and is consultant dentist to St Vincent’s Hospital, recounted a range of horror stories illustrated with gruesome images of teeth belonging to Australian nursing home residents, and outlined his plan to avert the coming ‘disaster’.

This included making dental assessments a mandatory part of ACAT evaluations and making gerodontology (aged care dentistry) a recognised dental specialty, with postgraduate courses available and compulsory placements in aged care facilities for undergraduate dentistry students.

Dr Foltyn also wants the Oral Health Assessment Tool (OHAT), made compulsory by the Commonwealth Government’s Better Oral Health in Residential Care program, to be promoted more and actually used for its purpose.

“The OHAT is mandatory but most facilities don’t use it,” he said. “A lot of nurses I talk to don’t even know what it is.” 

A full version of Dr Foltyn’s position on the implications of poor oral and dental health in aged care, and his suggestions to improve it, can be found in his response to the Productivity Commission’s draft report, Caring for Older Australians.

Tags: acat, aged, aged-care, ageing, australian-medical-association, better-oral-health-in-residential-care, caring-for-older-australians, death, dying, montefiori, ohat, oral-health-assessment-tool, palliative care, palliative-care-australia, pc, peter-cleasby, peter-foltyn, productivity-commission, st-vincents, steve-hambleton,

1 thought on “Doctors, dentists and death

  1. On the issue of doctors not having adequate facilities, I would like to comment. All our rooms are single or double rooms, with privacy curtains where necessary. All our beds are electric and we can certainly provide all the equipment needed. It is the doctors who are causing us the most trouble. Trying to get them here, having them turn up unannounced in the middle of a meal, having them not turn up at all, when we have booked them, getting them to sign medication charts properly, or at all, getting them to write scripts so residents are not without pain relief for days on end, as happens in our facility. Every time we try and liaise with them to find out what they want and how we can facilitate their visits to be better for them, they block any discussions. We are only too happy to do what they want, if only they would communicate what it was.

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