A new funding arrangement for hospitals looks like happening. Included in the deal are new initiatives affecting the delivery of aged care across the country. The Commonwealth is to be responsible for all aged-care programs and more aged-care beds are to be provided.

One of the announcements that has not received much publicity is that $96 million dollars, over four years, is to be provided to improve access to GP and primary health services in aged care.

I have long wondered why it has been deemed acceptable for frail Australians to have such limited access to decent clinical care. Therefore, it is pleasing to see that this issue has now been identified as a problem that needs a remedy.

Sadly, the suggested remedy will not work. Yet again, the real issue - which relates to aged-care staffing - has not been addressed and we have, instead, the usual tinkering around the edges. The joint media release from the Prime Minster, the Minister for Health and the Minister for Ageing states that there will be an increase in payments to GPs who attend aged-care homes.

GPs who provide at least 60 attendances a year will receive $1,500 and those who attend at least 140 times will have their payment more than doubled from $1,500 to $3,500 per annum.  Pocket money for doctors!

What is needed, of course, is to have more skilled staff working in our aged-care homes. The number of registered nurses on duty in homes has decreased considerably in recent years and there is far too much reliance on carers who are often working beyond their capability and training.

The aged-care home I visit has now decided that, like many other places, it no longer needs to have a RN on site at all times. One on call will be good enough. This is a place that has approximately 200 residents accommodated in independent living units, several hostels and a nursing home.

All of us who have had relatives in aged-care homes have seen, and felt, the distress when frail residents are bundled off in an ambulance to the emergency department of the local hospital simply because staff do not have the skills required to treat various health complaints and unexpected incidents that occur.

Dr Cathy Sloane, a doctor in private practice, identified many of the key problems in providing good clinical care to patients in aged-care homes in an interview on the ABC earlier this year.  She said that often GPs felt that they could not depend on unskilled staff to apply the required treatment.

Here is one of the comments written on the ABC web site after that program was broadcast.

At one time I was giving out meds. to 60 patients whom I did not know much about, worrying that the Sched 8 drugs were doing their job, but as most of them were not communicative, I could not tell. Management were in their office doing the Rosters or interviewing new 'clients'. Walking off after the shift knowing full well there was more to do, as you did. Worrying that the Care they were getting, whilst the EN's and Assistant's in nursing were doing a fabulous job, it began to resemble an Assembly Line of bodies in beds, all clean and dry, tucked in and sleeping, but what of their Total Care. Were they all lying there silently screaming and insane.

I (sadly) resigned.

Frail Australians are not in residential homes because they want a holiday or a rest. They are there because they can no longer be cared for at home. Many have chronic illnesses and complex health care needs. They need skilled care on a daily basis. They should have trained staff on hand and enough of them on duty to provide good, compassionate care.

Aged-care reform is now to be shunted off to the Productivity Commission for review (another one!). For some of us the solution re quality care is staring us in the face - more trained nurses in the homes and mandated staff/resident ratios.