At the recent Royal Commission hearings, the president of the Australian Medical Association made the observation that geriatricians rarely visit nursing homes.
The Hon Richard Tracey AM QC, Royal Commissioner, noted that, “It would be a rare day you would ever see a geriatrician in a nursing home. Is that a correct impression?”
Dr Tony Bartone, president of the AMA, replied in the affirmative.
We approached Dr Bartone about the issue, and asked why don’t we see more geriatricians visiting nursing homes, and what can be done to make their visits more commonplace?
Dr Bartone told HelloCare that general practitioners often find it difficult to access the support of geriatricians for their nursing home residents.
He said the AMA’s recent Aged Care Survey found that 71.2 per cent of respondents noted that access to ‘secondary support and consultation with specialists’ was ‘difficult’ or ‘very difficult’ for their nursing home patients to access when needed.
GPs would like to see aged care residents have greater access to geriatricians, he said.
“General practitioner members encourage increased access to geriatricians and other specialists when looking after nursing home residents,” Dr Bartone said.
“General practitioners are typically the first point of call for a resident’s health concerns, so GPs more commonly visit nursing homes than geriatricians,” Dr Bartone said.
When a patient’s needs become more complex, then GPs may call upon the support of a geriatrician specialist.
“Just like a consultation in a GP’s practice, if a patient’s medical situation becomes more complex, a GP may refer to a geriatrician for their expertise and advice,” he said.
Geriatricians are an “important part of the multidisciplinary team of health professionals that care for older people,” he said.
Dr Bartone said if residents don’t receive the care they need in a nursing home, they may be needlessly transferred to hospital.
“Timely access to appropriate medical care is essential for the health and wellbeing of the resident,” he said.
“If this does not occur, there is a risk to the older person’s health, and a risk that they will be transferred to hospital unnecessarily,” he said.
The ability to call upon the services of a geriatricians may be limited by their availability in the patient’s area, Dr Bartone said.
“Geriatrician services can be limited in rural, regional, and remote areas,” he said.
Considering Australia’s ageing population and the increased complexity of the health needs of aged care residents, demand for the services of geriatricians is likely to grow in the years ahead.
“Australia’s population is ageing with multiple chronic, complex conditions. Demand for geriatricians will only grow over time,” Dr Bartone said.
Dr Bartone said the government needs to provide more funding to encourage doctors to visit nursing homes.
“There needs to be better funding support for medical professionals to provide their services in nursing homes,” he said.
“There needs to be better integration between the health and aged care systems.
“There is fragmentation between the two systems as they are funded and governed by different levels of jurisdiction. For example, hospitals are state funded while nursing homes are commonwealth funded,” he said.
This article was originally published under the title ‘The geriatrician drought in our nursing homes’.
If finding a geritrician is rare the trying to access or get a visit from a psycho-geriatrician is like asking for rocking horse poo especially outside the metro areas and this is an area that the GPs are not especially specialised in.
Younger geriatricians are more comfortable working in hospitals where there is plenty of support and advice. It is more lucrative for older more established geriatricians to work from their consulting rooms where rewards eg. for Comprehensive Geriatric Assessment are pretty good. Home Visits, Attending RACFs and Remote Hospitals seem to belong more and more to the 20th Century in our increasingly entrepreneurial world.