Mental health, oral health and paramedical health

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Commissioner Tony Pagon QC opened the official Melbourne hearing from July 15-17, saying Royal Commission staff were working behind the scenes, however, he admitted some work had been delayed due to the coronavirus, c This is why the Commission has received an extension from the government until February 26, 2021.

Mental health is inadequate for older people in nursing homes

The Royal Commission noted that as of June 30, 2019, 49% of seniors permanently placed in senior care were diagnosed with depression. was a lack of access to support systems for the elderly.

Counsel Assisting Richard Knowles says the Commission finds funding for mental health support in residential senior care facilities insufficient compared to the high need for its services.

First witness of the first day, pseudonym UX, testified about her mother’s experience in a nursing home where she received insufficient support for her mental health.

UX says she didn’t think there was proper communication and action from institutions when concerns were raised about her mother’s mental health. Likewise, it was the same problem between their mother’s general practitioner and the staff at the facility.

The family has little confidence in the staff caring for their mother and say the way they manage the care and well-being of her mother is “a constant disappointment.”

UX adds that she constantly wonders if her staff have even read her mother’s care record and says defending her mother has become exhausting.

A panel of experts was interviewed by the Commission, the panelists were Dr Leanne Beagley, CEO of Mental Health Australia; Professor Sunil Bhar, clinical psychologist and professor of psychology at Swinburne University of Technology; and Mark Silver, social worker and coordinator of the Elderly Wellness Clinic at Swinburne University of Technology.

The three mental health experts expressed their views on the proposals put forward by the Commission regarding the access and need for mental health services for older people in care facilities for the elderly, as well as on the adequacy funding for these services.

All experts agreed that funding is currently insufficient and that older people are not getting the mental health care they need when they are in nursing homes.

Mr Silver said: “I think it has to be recognized that mental health is of equal importance to physical health and social recreational health, and I think it is something that needs to be reflected in terms of policies and how we look at funding.

“And I support any need – any request, basically, for improvement and increase in funding. I think there has to be some type of appointment of a key person at the facility level to take responsibility. emotional well-being and mental health. ”

Dr. Beagley mentions that senior care staff need to be better equipped to understand and identify mental health issues developed by residents.

“I see that there needs to be real improvement at all levels in the ability of the primary care staff in these facilities and the older residential care staff in these facilities to understand and recognize the signs of poor mental health, and in order to that they are able to identify and refer, ”says Dr. Beagley.

“But also for them to understand some of the key aspects of well-being and well-being support, in terms of the social bonds at the heart of maintaining a sense of identity that residential residents would struggle with,” by supporting coping strategies, the impacts of their physical illness on their mental health, thus reducing their isolation.

“All of these social factors, I guess, that are part of a wellness model and for me that’s the basis and the foundation before I start adding the specialist services on top of that.”

Professor Bhar believes that mental health services should be available frequently rather than episodically in the care of the elderly, as there is such a majority of people in these facilities who suffer from high levels of depression, anxiety and illness. ‘other mental health problems.

Oral health is expensive and inaccessible

On the second day of the Commission, the complexities and challenges associated with the dental health of older Australians were discussed.

Beryl Hawkins, 91, of Narembeen, NSW, gave a witness statement about her personal experiences with accessing dental care.

Ms Hawkins says the dentist is often too expensive, which is why she disliked annual check-ups and only makes an appointment if she has a problem.

In 2019, she had to have her teeth removed at a public dental hospital and then needed dentures.

There was a two-year waiting list for dentures made by the hospital, so she received a $ 1,000 voucher to go to a new set of dentures, however, it was only valid. for one of the four public suppliers in its region.

Getting dentures cost her $ 3,500, which she couldn’t afford as she lives on old age pension, Ms Hawkins had to dip into her funeral money.

“I am aware that there are so many elderly people who cannot afford prosthetics when they get older. And like me, I have not been able to eat for almost two years, eat any kind of food… ”Ms. Hawkins explains.

“When I asked if I could get [dentures] in my parcel, I was told: “We are not cutting teeth. But not having teeth and not being able to eat means a lot to you. You lose your appetite. You are not eating the way you should be eating. It’s very difficult. And I think it’s something that should be looked at. ”

An expert panel was then held with Professor Fredrick Allan Clive Wright AM, Clinical Professor, Center for Education and Research in Aging at Concord Clinical School, University of Sydney; and Dr Martin Dooland AM, Assistant Associate Professor at the University of Adelaide.

The two experts want the introduction of measurable indicators that would lead to good oral health care in the care services for the elderly.

This could include care plans covering oral health, regular oral health assessments with tools, referrals for residents to exams and treatments, regular training sessions for staff on the oral hygiene, health and care; and annual oral health assessments for all residents.

“I think the first thing to recognize is that oral health is a very small component of health and care for the elderly, but it is a very important component and oral health is actually related general health and quality of life, ”explains Professor Clive Wright.

“So when you are considering putting together the package for the elderly in the elderly care facilities, the guiding principle for me is the recognition of this small but essential component of general health and quality of life for include oral health components. ”

Dr Dooland added that it is unfortunate that the elderly care sector is not interested in oral health care or in training their staff in dental care. But he adds that the same can be said of the dental industry and its attitudes towards supporting seniors in community and senior care facilities.

Paramedical care is underutilized in the care of the elderly

On the last day of the Royal Commission, there was a small panel with Professor Esther May, Occupational Therapist and Executive Dean at the Academic Unit of Clinical Sciences and Health, University of South Australia, and Claire Hewat, CEO of ‘Allied Health Professions Australia (AHPA).

Professor May works extensively with senior care services and described her personal experience of struggling for eight months to get a podiatry assessment from her own mother.

She advocated for better access to paramedical health services after seeing her own mother not receiving the services as a priority in her care plan.

Ms Hewat explained that for a program like the one Professor May thinks her mother and the others should receive, the elder care system would have to take responsibility.

Professor May says, “The common issues you hear now are about the funding flows that determine the types of services provided rather than the needs of the individuals that determine the services that are to be provided.

“And if we can get that fundamental change, I think we will do ourselves a lot of good for all of us heading into our second half of life that we ourselves will want the services we are talking about today.

“I would like to go into a senior care facility or stay home knowing that I could easily access these supports that are going to allow me to continue to reach my full potential. And I don’t think we currently have that. . ”

Ms Hewat agreed with this point, saying that there is a systemic problem in the care of the elderly where paramedical services are not seen as a priority.

As a result of this panel, the Commission heard from some senior care providers and how they provide allied health services and programs to their residents.

Two witnesses from Southern Cross Care (South Australia, Northern Territory and Victoria), Dr Tim Henwood, Group Manager of Connected Living, Community Wellness and Lifestyle, and Josephine Boylan-Marsland, Executive Services, explained the role of paramedical care within their establishments.

Ms Boylan-Marsland was very positive about their paramedical health services at Southern Cross Care SA, NT, VIC, saying their gyms had resulted in a 67% reduction in hospital transfers over the past two years.

“We have no physical constraints other than maybe one or two requested bed rails. So we have a significant reduction in injuries. So if we were to look at the results and focus a lot on the results, we would say that this is the model, and we are improving the health and well-being of people, ”says Boylan-Marsland.

She adds that the management team is committed to a model where they shape “well-being” and not “unhappiness”.

Mr. Henwood says, “What we have are strong, passionate teams of people who truly believe our customers can have a positive change in their health and well-being, and we demonstrate it time and time again where we are. are capable of – able-bodied people, regardless of their age, illness or disability, regain a higher level of well-being. ”

The next Royal Commission hearing will be on August 10 in Sydney.


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