UNCOUPLING aged care from health care "does not serve the rights of older people in residential care to equitable access to health care".
Only days after his appearance at the Royal Commission into Aged Care Quality and Safety, Professor Joseph Ibrahim has warned the trend of uncoupling the two systems could affect clinical care of those in residential care.
In a perspective published online by the Medical Journal of Australia, the head of the Health Law and Ageing Unit at Monash University's Department of Forensic Medicine wrote that as residential facilities moved away from a "medically dominated model of care provision", acute care hospitals and state health departments were doing the opposite.
"[They] consider residential aged care facilities as a quasi-acute health care facility, evident by the implementation of In-Reach services and other efforts to divert presentation of residents to emergency departments," Professor Ibrahim wrote.
He said modern care of older people required better gathering and use of data, more robust governance structures and innovative models of care.
"Annual national data for evaluating the clinical management of frail older adults with chronic disease in residential aged care facilities is limited," he wrote, adding that the major danger for the royal commission was failing to address gaps because of the absence of empirical data.
Professor Ibraham said the extent of known poor clinical care includes overprescribing of antipsychotics; prevalence and severity of chronic respiratory conditions being under-appreciated and under-treated; poor diabetes management; poor oral care; sexual assault; and serious injuries and preventable deaths from falls, choking, suicide and resident assault.
"The royal commission needs to take a transformative approach that includes tightly coupling residential aged care facilities to health care," he wrote.
"Addressing the egregious human rights breaches and developing strategies to reduce and eliminate harm from abuse, mistreatment and neglect are crucial."
Professor Ibrahim said optimal health care should be a core role of residential facilities. "This requires the medical profession to establish new standards, identifying and bridging gaps in empirical knowledge, using performance data and advocating for the structural solutions that support promoting the use of evidence-based practice at the point of care."
The Medical Journal of Australia is a publication of the Australian Medical Association.
