The royal commissioners’ recommendation requiring providers to have the right equipment and staff to support specialist telehealth services is a positive measure but telehealth must be integrated into the system across all aspects of care, an industry CEO tells Australian Ageing Agenda.
The Royal Commission into Aged Care Quality and Safety’s final report, which was tabled in parliament on Monday, contains eight volumes and 148 recommendations to fundamentally reform the aged care system.
Royal commissioners Tony Pagone and Lynelle Briggs found telehealth helped avoid the potential harm and distress frail older people may experience when travelling to receive medical care and had become an important part of care delivery.
They said telehealth has become widespread as a result of the COVID-19 pandemic and noted the government’s November 2020 commitment that “telehealth will become a permanent part of the Medicare system.”
They’ve recommended that Medicare-funded specialist telehealth currently available to aged care residents be expanded to include older people receiving care at home.
The commissioners call on the government to require residential and home aged care providers to have the necessary equipment and clinically and culturally capable staff to support telehealth services.
Telehealth solutions provider Coviu founder and CEO Dr Silvia Pfeiffer said the recommendation was a step in the right direction towards a future-proofed, digitally transformed aged care sector.
“We’re on a path to digital transformation across the healthcare sector and it is one of those areas where we will be digitally transforming where more care will be provided through technology,” Dr Pfeiffer told AAA.
“If we don’t invest in building that technology basis in the facilities, we won’t be able to provide that transformation,” said Dr Pfeiffer, who has a PhD in computer science.
However, the recommendation refers to access to specialist telehealth services but aged care providers also need telehealth access to general practitioners and allied health professionals, Dr Pfeiffer said.
“Getting more GP visits into residential aged care providers is going to be increasingly hard with GPs being less and less incentivised to do that,” she said.
Telehealth can bridge the gap but it needs to look at all the aspects of a person’s health and care, Dr Pfeiffer said.
She said there are challenges in accessing oral health, exercise physiology and psychology in aged care.
“These services are important to keep mobility, dexterity and cognitive function in older people, so we have a big need for healthcare into these services and into these facilities. It won’t happen unless we have the technology available and we have a person on the ground that can help the older people receive those services,” she said.
Lack of support for primary care model
The commissioners also recommend the development of a new primary care model which requires general practices to apply to become accredited aged care general practices, receive an annual payment, and agree how care they will provide care to individual residents including via telehealth.
Commissioner Pagone recommends this model be trialled for six to 10 years to determine whether it is viable and commencing no later than January 2024 while Commissioner Briggs recommends it be implemented without trial from this date.
Dr Pfeiffer said the sector can’t wait 10 years to make telehealth a standard way to deliver care to residents.
“We’re thinking too slow. Experimenting with new models for 10 years is not going to solve our immediate problems,” she said.
“We had a pandemic and we had to rush to upskill everyone with telehealth and we were able to do that. Why would we need 10 years to ascertain that telehealth is the solution to our problems when we’ve done this for the last year? We’ve already we’ve got the data, we’ve got people using telehealth, it’s working.”
The Royal Australian College of General Practitioners said it does not support this model recommended because it created more barriers for GPs to provide services to aged care residents.
“The model suggests fundamental changes to GP care and adds an additional layer to accreditation or credentialing requirements for GPs and practices that are already in place,” the RACGP said.
RACGP president Dr Karen Price said GPs must be properly involved in the aged care system.
“This royal commission only highlights once again that there must be greater support for GPs to provide care in the aged care sector, particularly in residential aged care facilities. We must be better involved in designing systems which support older people to access health care,” Dr Price said.
She also said that improvements could be made in Medicare items for telehealth.
“Under the current system, aged care residents must be present when receiving a Medicare service by video or telephone,” Dr Price said.
“This requirement creates a barrier for patients to access care from their GP via telehealth. That is because it is common for GPs to discuss a resident’s condition with nursing staff at an aged care facility without the patient being present during this consultation, on request of nursing staff for advice and support,” Dr Price said.
Under current rules, rebates are unavailable for this type of care, despite being clinically necessary, she said.
“All we are asking for is separate items for GP services provided via telehealth for residents of these facilities, without patients being present.”
Continue to follow Australian Ageing Agenda in the coming days and weeks for many more stories on the royal commission’s final report and recommendations.