Systemic Changes to Improve Quality and Safety in Aged Care

Dr Gaveen Jayarajan has taken the time and effort to write this excellent submission to the Royal Commission into Aged Care Quality and Safety. I think this is a great start and support it. I have made the following suggestions – and would be very keen to hear more.

 

Key recommendations 1 and 2 are laudable but unfunded (remember aged care panels) – I would suggest the ACAI be retained or these activities count towards the new QI pip payment. 

Key recommendation 5 – I would recommend RACFs adopt an EMR which can accept EMR notes from GP EMRs Sachin B Patel is the man in regard to this

Key recommendation 6 : good idea, would further recommended funding of this via ACAI retention and QI payment

 

 

We can do better and we owe it to our elderly patients to do so. Read on!

 

19 January 2019

 

Doctors in Aged Care Facebook Group Submission to the Royal Commission into Aged Care Quality and Safety

 

‘Systemic Changes to Improve Quality and Safety’

 

About us

 

The ‘Doctors in Aged Care’ Facebook group was started in September 2017 as a closed Facebook group for all doctors in Australia working in residential aged care facilities (RACFs) or with an interest in aged care. Its purpose is for doctors to discuss, share knowledge and experience, and seek advice about the clinical, administrative and financial aspects of working in aged care.

It has since grown rapidly to 1100 members and includes General Practitioners (GPs), geriatricians, psycho-geriatricians, palliative care physicians and other specialists and junior doctors. Many of these doctors are working at the coalface of aged care on a regular basis and have a unique perspective and insight on the issues faced by RACFs.

Key focus

Our key focus in this submission are systemic changes from a GP perspective that will improve both quality and safety in RACFs. One consistent theme throughout our submission is the need for better oversight, communication between facility nurses and GPs and engagement with family members. While we also support mandated minimum nursing staff ratios with more Registered Nurses (RNs) employed, improved clinical handovers and other issues such as improving dietary quality and options for residents, for the purposes of this submission we will focus on the following five key areas:

 

  1. GP input into the clinical governance of RACFS

  2. GP feedback at accreditation visits

  3. GP involvement in case conferences with families

  4. Uptake of full Electronic Health Records within RACFs

  5. Recognition of significant amount of unpaid work

 

GP input into the clinical governance of RACFs

 

We believe there should be greater GP input in the clinical governance of RACFs given that residents are being admitted at an older age and with more chronic and complex medical conditions. We believe that GP involvement will provide another level of oversight of clinical and care issues that may impact on quality and safety. This is to complement (not replace) existing strong clinical leadership of experienced RNs working within RACFs on a day-to-day basis and to foster a greater understanding and engagement between facility nurses and GPs at a systems level. This at present exists to some degree in Medication Advisory Committee (MAC) meetings held at some RACFs where all issues relating to medication management are discussed within a multidisciplinary team which can include nurses, pharmacists and one or more GPs.

We propose that this either be expanded in scope or a separate committee be created such as a “Clinical Governance Committee” that includes a multidisciplinary team dedicated to open discussion of all clinical governance issues faced by an RACF at a local level. This could consist of nursing staff and carers as well as other healthcare providers such as a physiotherapist, occupational therapist, speech pathologist, dietician, pharmacist and GP. Meetings could be held quarterly and attendance by healthcare providers should be funded by the RACF at a time-based hourly rate commensurate with the providers’ training and experience. Attendance at these meetings could be in person or by phone or videoconference. Outcomes and actions from such a committee should be fed back to the senior management of the broader RACF group for implementation at a local level.

 

KEY RECOMMENDATION 1

Formation of local “Clinical Governance Committees” at each RACF with direct feedback of outcomes and actions to senior management of the RACF.

 

GP feedback at accreditation visits

The current experience of many GPs when a facility is undergoing an accreditation visit by the Australian Aged Care Quality Agency is that feedback is rarely sought from them about their perspective on how the RACF is meeting quality and safety standards. We believe that it should be mandatory for accreditors to get feedback from all visiting GPs to get a broad perspective on all clinical and administrative issues faced by these GPs working at the RACF, and in particular how these issues may be impacting on quality and safety. This could be through either face-to-face or phone contact and should occur at the start of the accreditation period and also when changes have been made to assess any improvements from the GP perspective. We do not believe that GPs need to be paid for this, as most would happily provide constructive feedback if it were likely to improve their experience of providing care and it would ultimately benefit the care of their patients.

KEY RECOMMENDATION 2

Accreditors to obtain feedback from GPs at their visits (initial and follow up).

GP involvement in case conferences with family

Currently GPs are able to bill through Medicare for up to five case conferences per year if clinically indicated with the amounts received dependant on: the duration of the conference; whether the GP organises and participates in the conference;[1] or just participates in a conference that has been organised by someone else.[2]

If the duration of the conference is greater than 40 minutes and it was organised by the GP (ie. item 743) they would receive $201.65 from Medicare plus $6.30 if the patient is eligible for the bulk-billing incentive (item 10990), so $207.95 in total. Hypothetically if this happened 5 times per year this would generate up to $1039.75 in billings per patient per year which is quite substantial. Currently we believe the majority of GPs working in aged are not utilising these item numbers sufficiently and if they did, or if it was easier to do so, it would not only dramatically improve the financial viability of GPs working in aged care, it would also have significant positive impacts on patient safety and quality due to the benefits of having a multidisciplinary team discussing patient care.

We believe it should be mandatory for all new residents of RACFs to have a case conference soon after admission within 6 weeks, and for this to involve nursing staff, a carer, the family and the GP as a minimum, with other allied health staff depending on the clinical and care needs of the resident (and resident attendance optional and depending on their cognitive status). This is an excellent time to set the scene for how the resident’s care is to be managed going forward and also to discuss Advance Care Directives (ACDs) regarding a resident’s end-of-life wishes. These discussions are often not done in a timely fashion or done over the phone with family where there is no remuneration for the GP for this time and work. Ideally this type of case conference should be done annually thereafter and be a focal point for the resident’s annual care plan.

Currently we note that these conferences are done to varying degrees. Some RACFs facilitate conferences as described above, others facilitate conferences with the family but not the GP and others facilitate conferences with two or more facility staff but without the family or the GP. We believe “admission” case conferences and “annual” case conferences should be done with all present to give the maximum benefit to the patient and all healthcare providers providing care to the patient. We also note that case conferences do not require all members to be present in person, so one or more participants may be involved by phone or videoconference, therefore there is flexibility in how these conferences can be scheduled and run.

We note that while GPs can also organise these case conferences with RACFs themselves this requires buy-in to do so from facility staff, thereby making it harder to schedule and arrange.

KEY RECOMMENDATION 3

Mandatory admission case conference for all new residents followed by an annual case conference thereafter utilising existing Medicare item numbers.

Additional case conferences (either organised by the GP or another party) should be based on clinical indication and we believe that GPs should be invited to participate in all of these conferences (assuming they haven’t organised it themselves) with the patient/family consent. Often case conferences are held by RACFs with families with no GP invitation or input. We consider that there is significant benefit to patient safety and care in having the GP involved and engaged with family members in this way. We also note that this is a remunerated way of staying in regular contact with family without resorting to unpaid phone calls, emails or discussions without the patient present thereby again improving the financial viability of GPs working in aged care.

For these “additional” case conferences we believe the Medicare Benefits Schedule (MBS) rules need to be reviewed to make it easier for GPs working in RACFs to utilise these more frequently. Currently three different healthcare providers need to be present at a conference, either in person or via video/teleconference, in order to meet the MBS rules. These healthcare providers can include a GP plus two other different healthcare providers such as a facility nurse and carer and cannot include family members. Firstly, it is not always easy to find the two other different healthcare providers due to everyone’s own day-to-day work commitments. Secondly, we believe most case conferences would benefit from family involvement. Therefore we propose that for these additional case conferences they only require a GP plus one other healthcare provider (not two, but still allow two or more if necessary) plus a family member, so still three different people, but allow the family member to be part of the three.

KEY RECOMMENDATION 4

GP invitation and involvement in additional case conferences held during the year as clinically indicated, with amendment to Medicare item numbers to facilitate increased utilisation.

Uptake of full Electronic Health Records within RACFs

In our experience there are several inefficiencies and risks to the GP and patients associated with RACFs that still have solely or predominantly paper-based patient records. Paper records can be hard to read and take nursing staff longer to enter. Furthermore, only one person can read and enter notes at a time. Clinical information is also often spread across multiple folders separate to the patients record, for example some maybe in the nurses’ station, others in a medication room or at the patient’s bedside. It makes providing adequate oversight much harder to do, which we believe is a major issue in RACFs. It also makes it harder for senior nursing staff, clinical care managers as well other healthcare providers including GPs to monitor clinical issues and care provided to a resident remotely and without being physically where the relevant paper folders are.

We note that there are RACFs who have moved to almost full electronic health records for clinical, care, medication management and administrative functions and the efficiencies this provides and the benefits to improving quality and safety are significant. In particular these benefits are greater if the records are cloud-based, which allows for access from any device and web browser. We also note that other RACFs use a hybrid system where some records are electronic and other aspects remain on a paper-based system. Others remain in a completely paper-based system.

The benefits of full electronic health records are significant, for example the GP can be at the bedside of the patient and pull up all the information they need to make any clinical decision at the point-of-care when they need it the most, without spending time chasing up the various folders in different locations. Any gaps in the information required can be seen instantly with a quick scan of the relevant sections in the electronic record. This can also be fed back to facility nurses to ensure compliance with GP clinical and care directives.

KEY RECOMMENDATION 5

All RACF providers to move to full electronic health records , with a preference for cloud based software, for their residents within 2 years.

Recognition of significant amount of unpaid work

One recurring theme among GPs working in aged care is the vast amounts of unpaid work required. This comes about as GPs usually attend a facility approximately once a week and for the remainder of the week may work in their usual practice. During this time they still need to be on-call and available by phone, fax or email to RACFs to contact them. This work is not remunerated by Medicare and acts as a strong disincentive for GPs who work in a regular practice to continue to care for their patients as they enter an RACF. Examples of unpaid work for GPs working in aged care include: responding to phone calls/emails from/to nursing staff and families, writing prescriptions when off-site, completing letters of capacity, guardianship tribunal forms, Coroner’s reports, taxi vouchers and disabled parking permits, family meetings when the patient is not present, completing Advanced Care Directives (ACDs) when the patient is not present and completing death certificates.

A number of options could be considered to reduce this disincentive. We believe this should initially be focussed on remunerating unpaid phone calls taken directly by GPs from/to facility nursing staff or family members of patients. This will create an incentive for GPs to provide direct access to nursing staff at RACFs to deal with urgent/important clinical issues when they are not on-site and will also enable GPs to engage with family members about their loved ones more frequently. This could be done by phone or videoconference.

RACFs could therefore be a good starting point to introduce more MBS-funded telehealth item numbers. These could be untimed and start with a fixed fee per phone or video call and include a limit on the number of times it can be claimed per day. For example $15 per call with a limit of 5 calls per day. And with no requirement for the patient or other healthcare provider to be directly present at the telehealth consultation, as we note that the current telehealth items are only for a GP to sit in on a consultation between a patient and specialist.

We do recognise there were recent changes to Medicare item numbers for aged care (commencing 1 March 2019) by introducing a $55 call-out fee per visit (applicable to only 1 patient seen during that visit). However we note that at the same time the actual minimum rebate for each consultation was reduced. When the financial impact of this is compared before and after the changes, we view these changes as ineffective. For example if a GP were to see seven patients in a visit, before the changes the GP would generate $286.65 per visit, after the changes they would generate $318.20, so just $31.55 more. In our view this benefit is highly unlikely to encourage more GPs to visit RACFs. Furthermore if a GP were to see say 20 patients in a visit, before the changes the GP would generate $810 per visit, after the changes they would generate $807, so $12 worse off (both calculations exclude the bulk-billing incentive item number 10990 for simplicity). Even if a GP were to marginally benefit from this change due to seeing lower numbers of patients per visit, this benefit is far outweighed by the planned removal of the $5000 Aged Care Service Incentive Payment (SIP) worth up to $5000. So the recent Medicare changes are more likely to see GPs worse off financially (assuming the SIP is removed).

KEY RECOMMENDATION 6

Introduce new Medicare item numbers for GPs visiting RACFs for telehealth consultations directly with facility nurses and family members regarding their patients.

Doctors who supported this submission

Dr Gaveen Jayarajan

 

Dr Nick Tellis

 

 

[1]Medicare Benefits Schedule, Medicare item 735, 730 and 743.

[2] Medicare Benefits Schedule, Medicare item 747, 750 and 758.

 

 

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Feeling down about Depression?

(Cross posted from the ThinkGP blog)

 

Many years ago, coming to general practice from an emergency medicine background, I sat down with a group of trainee GPs. We started to talk about what we would see in general practice. I’d been working as a locum in general practice for a year and I thought I knew everything. ‘Coughs and colds are the bulk of the work’, I confidently declared. Those older and wiser than me set me straight, and told me that general practice is all about depression and anxiety and that it’ll be a rare consult where these won’t play a role. They were wise words then and now, so let’s talk about major depression in general practice.
 

The books would describe major depression as a subjective diagnosis which depends on reported symptoms rather than objective signs. There are cardinal symptoms of depression, rather than signs. Five or more of the symptoms below, present most of the time nearly every day for at least two consecutive weeks. Depressed mood or loss of interest or pleasure must be present. The symptoms cause substantial distress or impair function, and they are not better explained by substance abuse or a general medical problem. They are over and above what the GP thinks would be normal given the patient’s situation.
 

depression

 
The GP who relies on books alone will be well read… and alone. Listen to the patient! It’s a mood disorder. How do they feel? How do they make you feel? Clinical gestalt is the theory that healthcare practitioners actively organise clinical perceptions into coherent construct wholes, or simply put, how experienced GPs can spot depression a mile off. Listen to your gut. Countertransference can be a powerful tool to show you where you need to go. We’ll come back to the Art of General Practice later. Experienced GPs can’t be everywhere, and so we need some other ways to screen for depression.
 

Enter the rating scales for depression. They read like the alphabet – PHQ-9, BDI, HDRS. They can be used for screening and measurement of progress. Perhaps only 50 percent of patients with major depression are identified without screening [1]. Patients may not volunteer depressive symptoms without direct questioning for many reasons including fear of stigma, a belief that depression is not a matter for primary care, or a belief that depression isn’t a “real” illness but rather a personal flaw, as well as concerns about confidentiality and antidepressant medication [2].
 

In Australian general practice, we use the K10 and the DASS21 or 42. These are validated, easy to administer, reproducible, and recognised as part of the Mental Health Care Planning process. This enables patients with diagnosed depression to obtain a Medicare rebate for psychological therapy with a psychologist. American studies show patients are scared of psychiatric referral. Australian GPs are also scared of psychiatric referral, as it can be hard work to access private psychiatry. MBS item number 291 comes to the rescue and many psychiatrists will use this. They also know that depression masquerades as a variety of somatic symptoms. Untreated depression is associated with decreased quality of life and increased mortality. Depression can be successfully treated and treatment is effective. The earlier the better!
 

I recommend non-pharmacological treatment regularly. Exercise, diet, psychotherapy, GP counselling, reducing drug and alcohol use, getting more and better sleep are all options. These take time and effort, both from the patient and the GP. Remember, your time and presence are important to your patients. Ten minutes of education on diet and exercise can be worth months of medication and the effect can be long-lasting. Red flags include significant physical signs (weight loss is the big one in my opinion) or symptoms such as suicidality or psychosis on mental state examination.
 

Depression is not just a chemical imbalance. No pill can defeat the entirety of the patient’s life and circumstances pushing them in the wrong direction. The good GP will consider the patient in their environment and have an awareness of the social determinants of depression. Personality disorders, illicit drug use, and past abuse can lead to poor life choices and situations. Think about these before printing out a script.
 

When selecting an antidepressant, ask the patient what they’ve been on before. Ask about expectations and experiences and how they define success or failure. I tend to use medications that I’m familiar with and can then counsel patients accordingly. I find SSRIs to be an appropriate first line treatment. The side effects that concern my patients are anticholinergic (dry mouth), sexual (decreased libido and prolonged time to orgasm/ejaculation – so common that medications are now marketed for this purpose alone), and changes in sleep (too wakeful and agitated or too sleepy and hungover). I combat these with the advice to drink plenty of water and to time your medication according to how it makes you feel.
 

Traditionally, antidepressants are taken in the morning, but for those with a significant anxiety component, evening dosing is best. Trial and error will determine the optimal time for a good night’s sleep with no morning hangover. Sexual issues often require a change in medication. The newer medications promise fewer sexual issues, but often an older alternative can achieve the same goals at much lower cost.
 

depression2

 
The literature tells us the most resistant symptoms to treatment are insomnia, followed by sad mood, and decreased concentration. Depression is more likely to reoccur if these symptoms are persistent. I find that fatigue, anhedonia, guilt, worthlessness, and poor concentration are the hardest symptoms to treat successfully. It can be a long road for the patient (and the GP) back to wellness, and it can be hard to stick with treatment over time.
 

GPs have used many strategies to improve treatment adherence and all of us will remember pre-contemplators from our studies. We all get frustrated when patients don’t take our advice but providing information and warning of future consequences doesn’t always work. However, a solution is in clear sight. GPs have a fantastic and privileged therapeutic relationship with their patients, and can use this to capitalise on the essential window of time before you deliver your medical advice. This “privileged moment for change” prepares people to be receptive to a message before they experience it. Robert Cialdini has coined the term ‘pre-suasion’ to describe this. The therapeutic relationship allows pre-suasion, and therapeutic change can then be addressed, with consideration of the patient’s motivation, opportunity, and ability.
 

You can see the themes above of time and a relationship as potent therapy for the management of major depressive disorder in general practice. The initial clinical gestalt and the ongoing therapeutic relationship can be powerful tools for change. Depression is subjective and has been part of the human condition throughout history. This gives us all we need to move forward. Focus on the whole person sitting in front of you. Give them your time and expertise, be thorough, be kind, and be present. It therefore seems fitting to end with the words of a doctor from another time:

 

“The three grand essentials of happiness are: Something to do, someone to love, and something to hope for.”


Alexander Chalmers (29 March 1759 – 29 December 1834)




If you are worried about depression, anxiety, or have any other mental health concerns, reach out:

ACIS 131465 (South Australia – Acute Crisis Intervention Service)

Your GP at Partridge Street General Practice

Dr Gareth Boucher
Dr Ali Waddell
Dr Emmy Bauer
Dr Nick Mouktaroudis
Dr Nick Tellis

Beyond Blue & Beyond Blue New Access (free mental health coaching)

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Reach Out

References

  1. Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet. 2009 Aug;374(9690):609-19
  2. Bell RA, Franks P, Duberstein PR, Epstein RM, Feldman MD, Fernandez y Garcia E, Kravitz RL. Suffering in silence: reasons for not disclosing depression in primary care. Ann Fam Med. 2011 Sep;9(5):439-46.

Thanks to Klarem for the beautiful picture above, Marcia Vernon for the Beyond Blue link, and the guys at ThinkGP for their editing and help. 

 

 

Welcoming Dr Gareth Boucher to Partridge Street General Practice

 

Partridge Street General Practice is very happy to have Dr Gareth Boucher with us long term.

 

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Dr Gareth completed his undergraduate medical studies in Auckland and all of his post-graduate training has been in Adelaide. His medical areas of interest include:

 

  • babies and kids (neonates and paediatrics)
  • emergency medicine,
  • chronic disease management
  • palliative care

 

Outside of work Dr Gareth enjoys cycling, skiing, and photography.

 

 

dr-gareth-boucher-cycling

 

He is a GP Palliative Shared Care Provider, as are Dr Tellis and Dr Mouktaroudis. We’ll let Dr Gareth explain this:

 

 

What is palliative care?

Palliative care is holistic care of people with life-limiting illnesses.  Holistic care means we focus on them, not their illness!

Their goals and ambitions

Their mental, physical, and spiritual well-being

Their symptoms

Their dignity

 

We provide care in the community and co-ordinate service providers. We support patients and their families to maintain quality of life and achieve the outcomes important to them.

The Team at Partridge Street General Practice is able to help you and your family with any Palliative Care needs.

 

 

Partridge Street General Practice is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx and our local Medical School at Flinders University.

 


This means that the GPs at Partridge Street General Practice are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

 

Award Winning Responsibility!

 

 

All of our doctors here at Partridge Street General Practice are fully qualified ‘Fellows’ holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital) or are studying towards these qualifications. This is our minimum specialist standard and we may have other qualifications and skills.

 

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.
We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at Partridge Street General Practice with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

Dr Gareth Boucher is a key part of our growing Clinical Team.

 

Dr Gareth Boucher

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Katherine Astill

Dr Nick Mouktaroudis

Dr Nick Tellis

Driving. Dementia. Decisions. 

General Practice is the greatest vocation there is. Every day GPs are proud to use their skills and training to help their patients have better health and better lives. It’s incredibly rewarding for us and our patients (and the statistics!) show that it’s rewarding full stop.

 

 

Recently, Dr Tim Senior answered the question ‘Do we even need Doctors?‘. He concluded that GPs ‘know what to do when we don’t know what to do. And I can’t think of any other profession we can say that about’. So let’s have a look at a topic where GPs have to make hard decisions when we don’t know what we have to do.

 

 

Big Australia!

 

Australia has an aging population and Australia is big. Really big! Driving and Australia go together like Vegemite and Toast! What do we do when aging drivers see their GP and we make a diagnosis of Mild Cognitive Impairment or Dementia?

 

 

What are the GP’s responsibilities?

 

 

Here is the excellent Dr Genevieve Yates with a very personal and professional view on the matter.

 

 

 

 

 

Here is another excellent video from Professor Joe Ibrahim.

 

 

 

 

In South Australia we have clear(er) guidelines on Fitness to Drive, with Mandatory Reporting and the associated safeguards for GPs who report patients they believe to be impaired. It’s still a hard decision. For example, just look at Kate Swaffer who has been diagnosed with dementia. What would you do?

 

 

Tough Decisions

 

 

 

What would I do? I’m not sure. Every patient is different and that’s one of the reasons why General Practice is, as I said above, the best vocation in the world. GPs will keep learning every day of their professional lives to serve their patients better. My advice to patients is to See Your GP, your best source of information, advice, and support for all of those hard decisions, when you don’t know what to do.

We’re Here to Help.

 

 

Here to Help

 

 

NEW: We can now refer for sub-specialist driving assessments!

 

DR NICK TELLIS

Your Specialist In Life

DR NICK MOUKTAROUDIS

DR GARETH BOUCHER

Dr Gareth’s Cycle of Care

DR PENNY MASSY-WESTROPP

Dr Penny Massy-Westropp

DR MONIKA MOY

Dr Monika Moy

DR KATHERINE ASTILL

Dr Katherine Astill 1

Superpowers and The new Advance Care Directives Act 2013 (SA)

photo

 

Just revisiting an old post after listening to a great podcast – ‘The Good GP‘. It got me thinking. We know that General Practice is a good thing and reduces hospitalization rates (and hence healthcare costs) – but how can we measure this in our own practices?

 

 

Professor Barbara Starfield’s work clearly demonstrates that countries with a strong GP-centred system have much better health outcomes than countries that don’t.

 

 

Maybe utilization of Advance Care Directives could be part of this?

 

 

Read on!

 

 

We have all wished for superpowers – I know I have! Flying, changing the past, and predicting the future would all be fantastic abilities to have. I can’t promise the ability to fly, nor can I give you last weeks winning Lotto numbers prior to last weeks draw. However, I can predict the future for you. At some point in the future, all of us will be unable to make decisions for ourselves. We may be unlucky enough to be in an accident, have a severe illness, or we may just be facing the final stages of a long life well lived, but the time will come. I was lucky enough to hear Dr Chris Moy speak eloquently on some changes to the law here in South Australia that will give all of us the power to have decisions made for us, according to our wishes, if we cannot express them at the time.

 

 

Why is this important?

 

 

This is why.

 

 

 

 

From SA Health:

 

From 1 July there will be a clear decision-making framework and new protections for health practitioners when they find themselves in the difficult position of trying to determine what someone in their care might want, at a time when their patient’s ability to make decisions is impaired.

 

 

Plan Ahead

The new Advance Care Directive Form replaces the existing Medical Power of Attorney, Anticipatory Direction and Enduring Power of Guardianship with a single Advance Care Directive Form (however any of these existing forms will continue to have legal effect post 1 July 2014).

The Advance Care Directive Form allows individuals to appoint substitute decision-makers and/or to clearly document their values, wishes and instructions with respect to their future health care, living arrangements and other personal matters.

 

 

Make the Decisions They would want!

 

 

You can find the form here:

 

 

And you can find some further information here:

Or you can complete it online here:

 

Use your new power wisely!

 

 

Remember, if you have any questions, ask Your GP!

 

 

 

Dr Gareth Boucher

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Katherine Astill

Dr Nick Mouktaroudis

Dr Nick Tellis

 

 

We can Help

 

UPDATE:

From David Coluccio of Senexus Aged Care Solutions!

Hi there,
http://www.linkedin.com/pulse/two-small-pieces-paper-guaranteed-save-your-family-time-coluccio 
Kind regards, David

UPDATE 2:

What are the costs of aged care?

Read here and any questions? Partridge Street General Practice are Here.

UPDATE 3:

Some further reading on end of life care!

 

 

 

And there’s more…

 

 

Most nursing home residents want CPR if their heart stops in the belief they’ll have a good outcome, a national survey reveals.

While survival rates after cardiac arrest are as low as 5% for older people receiving CPR, a survey of more than 2000 nursing home residents found 44% believed they had a good chance of recovering.

“This view is perhaps not surprising given that opinions about the likely outcomes from CPR are often informed by television medical dramas,” said researchers from Monash University.

The misplaced perceptions likely explained why 53% of residents expressed a desire to receive CPR in the event of cardiac arrest, they added.

“These findings highlight the need for older people to be better informed about cardiopulmonary resuscitation, including a clear understanding of what is involved … and a realistic perception of outcomes,” they suggested.

The researchers said the wide gap between expectations and reality also showed the need for novel approaches to end-of life planning in nursing homes.

A new ‘Goals of Care’ model had been developed to replace the old ‘Not For Resuscitation’ orders, they noted.

Under this system, the doctor could assign a patient to curative, palliative or terminal phases of care, based on an assessment of their likely treatment outcomes.

“This transfers the technical medical decision-making responsibility to a physician, who can work with the preferences of the patient or resident, but has an understanding of how likely it is for victim to achieve their previous health state,” the authors explained.