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ROYAL COMMISSION: Mental health, oral health and allied health

The Royal Commission into Aged Care Quality and Safety held its first hearings last week since their postponement due to COVID-19, which covered mental, oral and allied health services and the difficulty older people in aged care have accessing these services.

Commissioner Tony Pagone QC opened the first Commission hearings in Melbourne since their COVID-19 related hiatus. [Source: Aged Care Royal Commission]
Commissioner Tony Pagone QC opened the first Commission hearings in Melbourne since their COVID-19 related hiatus. [Source: Aged Care Royal Commission]

Commissioner Tony Pagone QC opened the official Melbourne hearing, running from 15 - 17 July, stating that the Royal Commission staff has been working behind the scenes, however, he admitted that some work has been delayed due to the coronavirus, which is why the Commission received an extension from the Government to 26 February 2021.

Mental health is inadequate for older people in nursing homes

The Royal Commission highlighted that as of 30 June 2019, 49 percent of older people in permanent aged care had a diagnosis of depression, however, the sector has inadequate treatment for conditions, staff lacked skills to care for residents with mental health issues, and there was a lack of access to support systems for people in aged care.

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

First witness for the first day, pseudonym UX, gave evidence about her mother's experience in a nursing home where she has received inadequate support for her mental health.

UX says she didn't think there was appropriate communication and action by facilities when concerns were raised about her mother's mental health. Similarly, that was the same issue between their mother's General Practitioner and the staff at the facility.

The family has little faith in the staff providing care to their mother and says the way they deal with her mum's care and wellbeing is "a constant disappointment".

UX adds that she constantly wonders whether he staff even read her mother's care file and says advocating for her mother has become exhausting.

A panel of experts were questioned by the Commission, panellists were Dr Leanne Beagley, Chief Executive Officer (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 Wellbeing Clinic for Older Adults at Swinburne University of Technology.

The three mental health experts expressed their views on the propositions put forward by the Commission around access and need for mental health services for older people in residential aged care, as well as how adequate the funding is for these services.

All experts agreed the funding is currently inadequate and that older people are not receiving the mental health care they require while in nursing homes.

Mr Silver says, "I think there needs to be a recognition that mental health is equal in importance to physical health and social recreational health, and I think that’s something that has to be reflected in terms of the policies and the actual way that we view funding. 

"And I support any need – any, basically, request to improve and increase funding. I think there needs to be some type of appointment of a key person at a facility level to take responsibility for emotional wellbeing and mental health."

Dr Beagley mentions that aged care staff needs to be better equipped to understand and identify when mental health issues have been developed by residents.

"I see there needing to be a real improvement across the board in the capacities of primary care staff in those settings and aged residential care staff in those settings in understanding and recognising the signs of mental ill health, and so that they are able to identify and refer," explains Dr Beagley.

"But also so that they understand some of the key aspects of wellbeing and supporting wellbeing, in terms of the social connections at the core of maintaining a sense of identity, that residential residents would be struggling with, supporting coping strategies, the impacts of their physical illness on their mental health, reducing their isolation. 

"All of those social factors, I guess, which are part of delivering a wellbeing model and for me that’s the basis and the foundation before you start to add the specialist services on top of that."

Professor Bhar believes that mental health services need to be frequently available rather than episodic in aged care because there is such a majority of people within these facilities that experience high levels of depression, anxiety and other mental health issues.

Oral Health is expensive and not accessible

On the second day of the Commission, the complexities and difficulties associated with dental health for older Australians was covered.

Ninety-one year old Beryl Hawkins from Narembeen, New South Wales, provided a witness statement around her personal experiences accessing dental care.

Ms Hawkins says that often the dentist is too expensive, which is why she didn't like to go for annual check-ups and only sets up an appointment if she has an issue.

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

There was a two year waiting list to get dentures made by the hospital, so she was provided a $1,000 voucher to go towards a new set of dentures, however, it was only valid for one of the four public providers in her area.

Getting dentures cost her $3,500, which she could not afford because she lives off the age pension, Ms Hawkins had to dip into her funeral money.

"I’m aware that there are so many elderly people that can’t afford dentures when they get old. And like me, I haven’t been able to eat for nearly two years, eat any kind of food…" explains Ms Hawkins.

"When I asked if I could get [dentures] from my package, I was told, “We don’t do teeth.” But not having teeth and not able to eat, it means an awful lot to you. You lose your appetite. You don’t eat as you should eat. It’s very hard. And I find that it’s something that should be looked into."

An expert panel was held next with Professor Fredrick Allan Clive Wright AM, Clinical Professor, Centre for Education and Research on Ageing at the Concord Clinical School, University of Sydney; and Dr Martin Dooland AM, Adjunct Associate Professor at the University of Adelaide.

Both experts wish for an introduction of measurable indicators that would achieve good oral health care in aged care services.

This could include care plans covering oral health, regular oral health assessments with tools, referrals for residents to checkups and treatments, regular education sessions for staff around oral hygiene, health and care, and annual oral health assessments of all residents.

"I think the first thing to recognise is that oral health is a very small component of health and aged care but it’s a very important component and that oral health is actually related to general health and to quality of life," explains Professor Clive Wright.

"So, when you’re considering putting together the package for older people in aged care facilities, the driving principle for me is the recognition of that small but essential component of general health and quality of life to include oral health components within it."

Dr Dooland adds that it is unfortunate that the aged care sector hasn't been interested in oral health care or education of their staff around dental care. But he adds that the same can be said towards the dental sector and their attitudes towards supporting older people in the community and residential aged care settings.

Allied health is underutilised in aged care

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

Professor May works extensively with aged care services and described her personal experience fighting for eight months to get her own mother a podiatry assessment.

She advocated for more access to allied health services after witnessing 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 believes her mum and others should receive, it would require the aged care system to take responsibility.

Professor May says, "The common issues that you hear now are around the funding streams driving the types of services delivered rather than the needs of the individuals driving what services should be provided. 

"And if we can get that fundamental shift, I think we will do ourselves a lot of good for all of us that are moving towards our second half of life of which we ourselves will be wanting the services that we’re talking about today.

"I would like to go into an aged care facility required or stay at home knowing I could easily access those supports that are going to enable me to continue to reach my full potential. And I don’t think currently we’ve got that."

Ms Hewat agreed with this point, saying that there is a systemic problem in aged care where allied health services are not seen as a priority.

Following this panel, the Commission heard from a few aged 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 allied health within their facilities.

Ms Boylan-Marsland was very positive about their allied health services at Southern Cross Care SA, NT, VIC, saying that their facility gyms have resulted in a 67 percent reduction in hospital transfers over the last two years.

"We have zero physical restraint other than maybe one or two requested bed rails. So, we have a significant reduction in wounds. So, if we were looking at outcomes, and we’re very much focused on outcomes, we would say that this is the model, and we improve people’s health and well-being," says Ms Boylan-Marsland.

She adds that the executive team has committed to a model where they shape "wellbeing" not "ill-being".

Mr Henwood says, "What we’ve got is strong, passionate teams of people who really do believe that our clients can have a positive change in their health and wellbeing, and we demonstrate that over and over again where we’re able to re-able people, independent of their age, their disease or their disability, back to a higher level of wellbeing."

The next Royal Commission hearing is running from 10 August in Sydney.

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