As the final hearing into the aged care sector takes place, stakeholders are calling for change – with one group calling for nothing less than a complete overhaul of the system
Counsel assisting during final submissions at the Royal Commission into Aged Care Quality and Safety have made 124 proposed recommendations, including a new Aged Care Act based on human rights principles for older people.
These recommendations are available here. They also include mandated staffing ratios in nursing homes, increased access to health services, and the inclusion of allied health care, including care from pharmacists, in residential aged care.
Another recommendation suggests people receiving aged care should have their access immediately improved to quality medication management.
This would mean allowing and funding pharmacists from 1 January 2022 to conduct reviews on entry to residential care and annually thereafter, or more often if there has been a significant change to the care recipient’s condition or medication regimen; as well as amending the criteria for eligibility for residential medication management reviews to include people in residential respite care and transition care; and monitoring quality and consistency of medication management reviews.
Also recommended is the restriction of the prescribing of antipsychotics, so only a psychiatrist or geriatrician can prescribe these, though GPs could prescribe repeats of scripts already written by one of these specialists.
The PSA said it strongly backs a number of the proposed recommendations.
In particular, PSA endorses the proposed recommendation that pharmacists be embedded within all aged care facilities across Australia.
PSA National President Associate Professor Chris Freeman said pharmacists were critical to ensure the safe and quality use of medicines in aged care.
“Counsel assisting has recognised the vital role of pharmacists in tackling the problems of overuse of opioids, chemical restraints and inappropriate use of antibiotics,” he said.
“PSA is pleased counsel assisting has adopted our recommendation for pharmacists to have a greater role in aged care and be embedded in these environments.
“We maintain pharmacists need to be able to spend more time on the ground in aged care, to be able to protect residents when it comes to the safe and effective use of medicines.
“The Aged Care Quality and Safety Royal Commission in its interim report has already recognised the urgent need to address the critical medicine safety failures in aged care.
“Our Medicine Safety: Aged Carereport found more than 95% of people living in aged care facilities have at least one problem with their medicine and most have three. Many of these problems are very serious, and potentially catastrophic.
“For too long pharmacists have felt powerless that the system has not supported them in addressing these problems.
“If adopted, these recommendations would provide real hope that our older and vulnerable Australians will receive safer care.”
PSA also said it endorses the establishment of benchmarking and public reporting of quality indicators which must include data on medicine safety.
Associate Professor Freeman said comprehensive indicators on the safe and quality use of medicines currently do not exist.
“The public reporting and measurement of this data is necessary to improve medicine safety,” he said.
“We know that when pharmacists spend more time on the ground in aged care they can make a meaningful difference to how medicines are prescribed and administered to improve safety for all residents over time.”
Associate Professor Freeman urged the Commission to adopt the recommendation to establish an aged care workforce planning division and an aged care workforce fund.
“PSA supports a staffing ratio of at least 0.5 FTE pharmacists per 100 residents,” he said.
“This will ensure that pharmacists have the time to properly address medication management issues within the aged care environment.”
PSA also welcomes the proposed establishment of a dedicated research council to conduct research into effective programs to improve the use of medicines in aged care.
“Up until now research into aged care has been ad-hoc and small-scale. This will provide a better opportunity to develop the evidence base for best practice models of care that will improve medicine safety for older Australians.
“Australians now know just how devastating medicine safety problems are among our aged care residents. They deserve action. Adopting these recommendations will begin to fundamentally shift aged care in a direction that finally makes medicines safer for all.”
Meanwhile the AMA called for “a complete overhaul of the aged care system”.
“Long before our first submission to the Royal Commission, the AMA has been calling for systemic reform to recognise that health and aged care are two parts of the same system that should be geared towards optimising the health and wellbeing of older people,” AMA President Dr Omar Khorshid said.
However, the GPs protested the recommended restrictions on who can prescribe antipsychotics.
“The AMA supports reducing the inappropriate use of antipsychotics. However, there must be a balance between the need to ensure the resident’s safety, and the safety of those around them, while respecting their right to dignity and self-determination, including acknowledging previously expressed or known values or wishes.
“While we welcome the recommendation for greater involvement of geriatricians in aged care prescribing, GPs, who are the main medical practitioners to visit aged care facilities, will still need to prescribe these medications from time to time – for the safety of the patient, the other residents, staff and visitors.”