From neglect to care, dignity and respect

It did not go unnoticed that the final report of the Royal Commission into Aged Care Quality and Safety released this week was titled Care, Dignity and Respect, a far more aspirational name than that which starkly laid out the findings of the commission’s interim report in October 2019: Neglect. That being said, if there was one sentence that summed up the findings of the final report and the national shame the royal commission has uncovered, it was this one: “Substandard care and abuse pervades the Australian aged care system.”

The 148 recommendations in the final report cover the gamut of issues facing the sector, from how to regulate it to how to fund it and how to ensure its vast workforce is equipped to adequately provide the care that appears to be so lacking. The final report also placed a good deal of emphasis on information, data and technology, which also appear to be sorely lacking.

“Discovering the extent of substandard care in any human service should be quite straightforward,” the report says. “In Australia’s aged care system, it is exceedingly difficult. Those who run the aged care system do not seem to know about the nature and extent of substandard care, and have made limited attempts to find out.”

The federal government promised an immediate half-billion dollar package as a stop gap and is promising more in the May budget. It is also trumpeting that aged care has been brought back into federal Cabinet with Health Minister Greg Hunt adding it to his portfolio last December. Both are a drop in the ocean, however, and there is no getting away from the fact that the whole system needs massive structural, regulatory and funding changes. The commissioners recommended that the 1997 Aged Care Act be torn up and everything started anew.

For the aged care technology sector, however, everything new is old again. Of the good number of recommendations concerning technology and data, one or two stood out. Recommendation 68 called for universal adoption of digital technology and the My Health Record, stating that the Australian government should require that by July 2022 every approved provider of aged care delivering personal or clinical care uses a digital care management system, including an electronic medication management system.

We don’t think there’s a hope in hell of that happening. If aged care providers can only afford $6 a day on average for resident meals and the biggest issue of all is an overworked, underpaid workforce, there’s little chance money for IT will be prioritised. The other part of the recommendation – universal adoption of My Health Record – is more likely, but what is adoption and what does meaningful use look like?

The commission seems to have heard what are longstanding calls for proper documentation at clinical handover, particularly between residential aged care and hospitals, and has nominated the My Health Record as the most obvious vehicle. This was also covered in the excellent The Architecture Practice (TAP) report from last year, commissioned by the Commission, and by the Aged Care Industry IT Council (ACIITC) in its recent CARE-IT report.

The thing is, we’ve heard it all before. It was a recommendation in the ACIITC’s 2012 Pathfinder report, and in the council’s submission to the PCEHR review in 2013. It has variously been discussed ever since, but as always, those discussions came to naught.

It wasn’t until just last month – nearly nine years after the PCEHR went live – that the Australian Digital Health Agency’s (ADHA) aged care advisory group met to discuss how to begin the process. Just as in every other aspect of aged care, its information technology needs have been neglected for too long. Can it be fixed? In time, yes, but not by July next year.

The Royal Commission report also had a lot to say about data collection and sharing, and thankfully has singled out the Australian Institute of Health and Welfare as the right vehicle to manage this in the future through the curation of a National Aged Care Data Asset. There are also calls for an increase in support for telehealth in residential aged care and for assistive technologies in home care. We’ve heard that all before too.

In other news, Phase 1b of the Covid-19 vaccination program is set to kick off in the next month, if the EU allows the shipments of the AstraZeneca vaccine to arrive that is. According to the AMA, the federal government has changed its original plan limiting vaccination to just 1000 sites and has this week informed over 4600 general practices that they will be part of the program and will receive on-boarding packs.

This means most practices will be able to vaccinate their own patients in this cohort and use their clinical judgement as to suitability. It might make booking and scheduling a lot easier too. The AMA says practices will receive between 50 and 400 doses a week, which will be far more manageable than originally envisaged. The GP respiratory clinics and Aboriginal Community Controlled Health Services who will also be providing vaccines in this phase.

Internationally, there has also been a lot of movement with what is variably being described as vaccine passports, vaccine certificates and health passes. This week, South Africa and Malaysia released their versions, while New York began a trial of IBM’s promising blockchain-powered digital health pass. The EU is also moving ahead on technical specifications for interoperability, and countries like France are beginning their discussions on the political and ethical challenges of a health pass.

We’re having it here too. In our poll last week we asked: Is a vaccine passport an invasion of privacy? The vast majority of our readers said it was not a problem: 86 per cent said no, 14 per cent said yes.

That brings us to our poll question for this week:

Is universal adoption of digital care management systems in aged care likely in the near future?

Vote here and feel free to leave your comments below.

Comments  

+3 # George Margelis 2021-03-06 11:22
Yes, but like healthcare it will be a long incremental journey which requires more than just buying software. It requires cultural change, workforce reform and education, local industry support and development and a strategy focused on improving the quality of life of older Australians whilst maintaining their safety and dignity.
It also needs the support of the digital health people who read Pulse-IT to share their learnings of the long journey in digital health.

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