New research has confirmed the sector is chronically understaffed, which GPs say is affecting quality of care.
The study, commissioned by two of Australia’s largest aged care unions and undertaken by academics from the University of New South Wales, Macquarie University and RMIT, describes an environment in which care workers are set very strict time limits for tasks, with no time allocated for social and emotional care.
According to the report, 87% of care workers interviewed by the research team said there was ‘not enough’ time to listen and connect with old people, and that attending to the social and emotional needs of older people risked being seen by managers as ‘slacking off’.
Clinical Co-Chair of Aged Care and Mental Health at South Western Sydney Primary Health Network, Dr Ken McCroary, told newsGP that understaffing combined with a lack of training and expertise are massive problems in residential aged care facilities (RACFs), to the point where they are ‘essentially endemic’.
‘It’s had an incredibly distressing impact on the standards and overall healthcare at these facilities,’ he said.
‘Improved nursing numbers and improvement in their skills or knowledge would greatly assist me in providing quality care in RACFs.’
Professor Dimity Pond, a GP with a special interest in dementia and aged care, believes the Royal Commission into Aged Care Quality and Safety should be a catalyst to generate more support and funding for RACFs and their staff, especially with GPs under increasing pressure to use fewer psychotropic medications.
‘It’s gone too far. There needs to be more trained staff and there needs to be more work done to determine what the ideal profile would be,’ she said.
‘As GPs, the concerns are particularly around medication management in residential care … when there’s a real shortage of staffing so we have pressure put on us to prescribe medication to try and to calm a patient who’s basically anxious, perhaps bored and maybe in pain.
‘Those people should be being looked after in the facility by the nursing staff using other techniques like distraction, like being taken for a walk outside, or like finding some sort of activity for them to do … [but] they’ve replaced registered nurses with enrolled nurses, or assistants in nursing, who don’t have very much training and especially they don’t have training in dementia.’
The Pharmaceutical Society of Australia (PSA) has also been critical of support for residents and staff at RACFs, with newly released data showing antibiotic prescription rates have risen, potentially increasing the risk of antimicrobial resistance.
The 2018 Aged Care National Antimicrobial Prescribing Survey (NAPS) found nearly 10% of aged care residents were prescribed antimicrobials – up from 8.8% in 2017 – while antimicrobial review or stop dates had not been documented for 58.9% of prescriptions.
NAPS also found the documentation of indication was missing for 25.1% of prescriptions, and that almost one-fifth of antimicrobials were prescribed for ‘as needed administration’, leading PSA President Associate Professor Chris Freeman to call for more pharmacists in RACFs.
‘Residents may be taking antimicrobials longer than necessary, or worse – when they don’t even need to,’ he said.
‘There is no clear finish date or prompt for a healthcare provider to check in with an aged care resident, or the care staff to make sure they are still taking or have ceased taking an antimicrobial based on their current health.
‘This lack of support to aged care residents, and to facility staff, is putting aged care residents and the wider community at risk from the epidemic of antibiotic resistance.
‘The report released today highlights the real necessity for pharmacists to have more time in aged care facilities and other health care teams to ensure doctors do the right thing with prescribing medicines so that we can improve the safe use of medicines within aged care.’
However, Dr McCroary said poor hygiene, rather than overuse of antibiotics, is more of a concern in relation to antimicrobial resistance in RACFs.
‘I’m seeing more and more MRSA [Methicillin-resistant Staphylococcus aureus] and preventable infections due to poor hand hygiene,’ he said.
‘During a recent gastro outbreak at an RACF I witnessed, nursing staff go from cleaning a patient with diarrhoea to inserting dentures in a different patient’s mouth with no hand hygiene. When questioned, the reply was “I don’t need to wash hands as I’m wearing gloves” – unfortunately, it was the same pair of gloves worn the whole time.’
Dr McCroary added that while he would support ‘any endeavour’ to improve patient safety and outcomes, he is not sure more pharmacists in RACFs would achieve help, nor that an increase in antibiotic prescribing could be automatically extrapolated to an increase in inappropriate use.
‘I’m not a fan of inflammatory statements with disingenuous agendas and would prefer collaboration to improve the care for the people I look after in nursing homes,’ he said.
‘Ideally, improved funding for multidisciplinary care in general practice development of team-based approaches would have a better likelihood of making a beneficial difference.’
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