Home' Australian Ageing Agenda : AAA May-Jun 2014 Contents RACFs is widely regarded as inadequate,
but the aim of developing a RACF into
a Community Hub is to improve care
through increased training and support
of staff, a wider range of services
coordinated on-site, and a new morale and
energy within the Community Hub, not
through higher staff-resident ratios.
Medical participation in the Community
Hub would normally be funded through
Medicare bulk-billing. An increase in
the fee-for-service payment for medical
practitioners and nurse practitioners
with appropriate postgraduate aged care
qualifications should be considered.
To constrain unnecessary medical
consultations in-house for RACF
residents, a basic stipend for doctors
offering care, calculated on a bed
numbers base, could be considered as an
alternative to fee-for service.
At the same time, it should be
anticipated that the vocational spirit
engendered in the work of the Community
Hub, as it is recognised for bringing about
major improvements in aged care, will
inspire all who participate in the exercise,
and help them consider the work as a
privilege rather than a business proposition.
INSPIRATION AND FURTHER
The idea for the Community Hub came
primarily through experience -- visiting aged
care facilities and seeing the difficulties
staff had in meeting the needs of residents,
the concerns of family members and the
various requirements set by authorities.
There seemed to be a dearth of medical
support, far too many drugs being
administered, too rapid disposal to an acute
hospital when some crisis presented.
I was accustomed to caring for
dying patients at home; that is the best
palliative care. A RACF is home to its
residents -- they should be looked after
there, and avoid the fears and intrusions
and strangeness of acute hospitals. So I
saw the need for stronger professional
support available round the clock. In
a brief conversation in 2013, Senator
Concetta Ferravanti-Wells, then shadow
minister for ageing, raised for me the idea
of a general practice based in a RACF, and
I have pondered this, read extensively
the literature and expanded the concept.
Already some RACFs are introducing GP
services on-site, but the equally-important
challenge is to bring the institution and
its local community into a mutually-
supportive and cooperating framework.
I invite wide consideration and
Professor Ian Maddocks was Senior
Australian of the Year 2013. An Emeritus
Professor at Flinders University, he was
the first chair of Palliative Care at Flinders
University, first president of the Australian
Association for Hospice and Palliative
Care and first president of the Australian
and New Zealand Society for Palliative
Medicine. Feedback on his proposal can be
sent to firstname.lastname@example.org.
high-quality aged care and do not wish to
undertake further training or participate
in a Community Hub.
Models where the total concept is
trialled, demonstrated and shown to
increase the standard of aged care without
unnecessary increases in cost will be
helpful, but existing RACFs can begin to
institute components of the vision as they
see opportunities to do so.
PAYING FOR IT
With regards to the establishment costs
involved, a variety of models is possible.
An RACF could fund the building of
the general practice and club facilities
and lease them to professionals or
Entrepreneurs could take financial
responsibility and manage lease
arrangements, or doctor/allied health
groups could undertake the financial
Alternatively, innovative approaches
to raising capital from superannuation
funds or corporate entities might be found
to underwrite the costs. The example of
what is being undertaken for school and
youth support by Social Ventures Australia
is encouraging of such possibilities.
With regards to running costs, no
increase in government funding for the
care of RACF residents beyond current
levels should be expected. Funding of
Hub, but political support at both federal
and state levels must begin to recognise the
value of a model that brings comprehensive
aged care and social welfare support
together in location and management.
It would be helped by the institution
of a new Medicare Benefits Schedule for
'elderly care practitioners' and qualified
nurse practitioners. It calls for appropriate
university courses comprising, in a single
award, aged care, psycho-geriatrics and
The concept and operation of the
model will need intelligent advocacy.
Essential to its success will be support
from the various stakeholders, including
federal and state governments, not-
for-profit and for-profit organisations
managing RACFs, the Australian Medical
Association, the Royal Australian College
of General Practitioners, nursing bodies,
geriatric and gerontology organisations,
universities and colleges.
A number of management models can
be envisaged by which the interests of the
major stakeholders could be coordinated.
Medicare Locals might be considered
as appropriate bodies to develop the
model and oversee its implementation in
consultation with stakeholders.
Inevitably, the concept of Community
Hubs will not be welcomed universally. For
example, some established practitioners
may claim that they are already providing
The Hub would open up its facilities to people
living in the community for consultations,
healthy ageing activities and services.
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