Mandating an explicit and measurable requirement that aged care providers maintain the mental health of residents is among proposals put forward by the aged care royal commission this week. 

The three-day hearing, the first since hearings were suspended in March due to COVID-19, is looking at how the aged care system interfaces with mental, oral and dental, and allied health care.

The hearing began on Wednesday in Melbourne where only royal commissioner Tony Pagone appeared live with all attendees connected via video conference technology.

Counsel Assisting Richard Knowles said they would test potential solutions for the shortcomings identified during the commission’s hearings in Canberra in December and elsewhere.

“Aged care recipients, and particularly those receiving residential aged care, are not getting the mental, oral and dental and allied health care they need and are entitled to,” Mr Knowles told the hearing.

Wednesday’s hearing kicked off with a focus on mental health with proposals from the royal commission including greater clarity on the role and responsibilities of residential aged care providers to maintain the mental health of residents.

Clinical Geropsychologist Dr Alison Argo and Clinical Geropsychologist Dr Diane Corser, both of whom have experience in the residential aged care sector and support multidisciplinary care and an embedded psychologist approach, were among witnesses called on Wednesday.

This week’s royal commission in Melbourne (clockwise from top left) Richard Knowles, Tony Pagone, Lynelle Briggs, Dr Alison Argo and Dr Diane Corser.

Mr Knowles asked whether aged care providers should be required by regulatory framework or quality standards to give residents a mental health assessment within a set time after entering the facility followed by a regular review of the assessment and plan.

Both witnesses supported this idea.

While a standard won’t fix the problems overnight, it goes a long way to getting people aware that they need to meet this for accreditation, Dr Argo said.

“[I]t gets them looking into education and getting them thinking about what they need to do. And certainly we’ve seen that play out, for example, in the hospitals at the moment, cognitive screening has now been put in the standard for inpatient,” Dr Argo told the hearing.

Dr Corser said a mental health assessment should be a part usual care.

“It can’t be something that is just sort of done occasionally or ad hoc. It’s such an important element of people’s quality of life and how they adjust and how they manage in their later years, that it should be just standard care,” Dr Corser told the hearing.

Royal commissioner Lynelle Briggs asked whether high level home aged package recipients should also have a mental health assessment as part of standard care.

Dr Argo said yes, but added every older person should have their mental health assessed from the first aged care service they access on.

“It’s impossible to … focus on their physical health and reducing falls, building strength and functionality, etcetera, without appreciating the mental health and the cognitive things that are going on,” she said.

“Those things should be being assessed from their entry into My Aged Care services and not waiting until there’s a need for higher care in the community and certainly not waiting until they’ve reached a point where they’ve entered an aged care facility.

“[It] probably brings this full circle to if we were doing this holistic care from the get-go, we would obviously be helping people stay in the community and less people would be needing to go into those aged care facilities in the first place.”

Better understanding of treatment needed

Dr Corser, who worked as an embedded psychologist in an aged care facility for a couple of years, said providers could do better on identifing and meeting the mental health needs for residents.

She said reasons mental health issues were not being met included people attributing the issues to older age or a part of ageing.

“They’re aware of the mental health issues but also there’s a bit of hopelessness and helplessness that we can actually improve people’s mental health once they enter the aged care facility.

“So, they haven’t had that experience where they’ve seen improvement with mental health because of the engagement with psychologists. Psychologists just haven’t been working in aged care,” Dr Corser said.

She said those attitudes would naturally change if there were more psychologists in aged care.

“Like in the aged care centre that I was working at, they’ve begun to see the value of how we could work well together and that there could be improvements in mental health with proper treatment.”

Family, staff mental health also key

Dr Corser said the mental health of family members and staff was also important for residents.

“If their families or the carers are burned out or the families don’t understand what’s happening with their parent or the staff aren’t feeling well enough to engage with this person, it can really impact on the residents.

“You see disengagement and where staff’s attitude changes toward people, they lack empathy when they’re overworked. Families kind of remain absent. They’re not connected so much because they’re feeling quite helpless themselves so, yes, very important,” Dr Corser said.

Future options

Other proposals being discussed at the hearing include:

  • fund mental health treatment plans for residents prepared by a general practitioner
  • fund mental health assessments and mental health treatment plans for residents by a psychiatrist
  • increase funding for psychologists providing psychological services to residents
  • incentivise psychiatrists and psychologists to attend residential aged care facilities
  • increase outreach services by state and territory government older person’s mental health services to wherever aged care recipients live
  • increase mental health training for personal care workers.

The hearing concludes on Friday 17 July.

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2 Comments

  1. From past experience at attempting to find a psychologist, psychiatric or even a counsellor that would visit and RACF was almost impossible as a lot of residents don’t have private health and the GP mental health care plans fund was being rejected by Medicare because they were in aged care.
    Yet statistics show a very large % of residents suffer depression and other mental health issues.
    It is not always because the need isn’t known it is because of the blocks in the pathway.
    The above suggestions are a good starting point

  2. What about those that enter care with undiagnosed mental health and in denial of any mental health issues? Speaking from personal experience I have an elderly relative who denies any mental health issues and yet it is known about how traumatic her past was. She is on an anti-depressant but that is only the tip of the iceberg. However if they lie at testing (happy to substitute any word for lie) what can aged care do? What about families who have covered for years and in denial about mental health issues. They may refuse or not accept a diagnosis on their aged relative.

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