Elder Care Patient Advocacy

Dorothy Kamaker MN RN (ICU) PA Cert, an Independent Patient Advocate (http://patientadvocates.com.au/about-us.html), of Patient Advocates Australia (http://patientadvocates.com.au/index.html) will present this seminar.

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According to Dorothy:

Sick children and the sick elderly are the most vulnerable members of society. Without someone with knowledge and experience of the health system to prosecute their best interests and monitor their care, a good health outcome can be a lottery.

A report released in the BMJ in May 2016 claims the third highest cause of death (http://www.bmj.com/content/353/bmj.i2139) in the USA is medical mismanagement by either omission or commission. Approximately one third (http://content.healthaffairs.org/content/30/4/581?ijkey=1bb22e5a3c41001292fd62b59cbe31d9c19dafe4&keytype2=tf_ipsecsha) of patients will experience an “adverse event” and in Australia, because of its high incidence of error and complications, at least one major hospital group has been forced by Bupa to forgo payment (https://ama.com.au/ausmed/medical-errors-will-cost-major-hospital-operator) if any of its members are harmed by serious medical errors at any of its institutions in order to be an ‘approved’ provider. In April this year the Baird government bowed to nursing home industry lobbyists and abandoned the requirement for around the clock registered nursing presence (http://www.smh.com.au/nsw/nsw-government-abandons-247-nursing-in-aged-care-homes-20160430-goium1.html#ixzz47Lm8JATI) in care homes for the aged.

Hospitals and medical management are not for the young, the elderly, the inexperienced or the faint hearted and blind faith by anyone in healthcare service providers is at best naïve and negligent of the interest of the patient.

The NSW Health Policy Directive on Patient Rights & Responsibilities (http://www0.health.nsw.gov.au/policies/pd/2011/pdf/PD2011_022.pdf) provides:

“Patients should ensure that all questions have been asked, particularly those of greatest importance to them. Before giving consent for treatment, they should fully understand the processes involved in their treatment. If necessary, a healthcare interpreter, family member or authorised person should be present to clarify information.”

This is the ultimate ‘caveat emptor’ issued to a population who will almost certainly be emotionally, cognitively or physically at their lowest ebb and often unable, in the pressure of the short time available to them face-to-face with the healthcare worker, to do any of these things. Most are stressed and unable to cope and feel ‘under duress’ to be compliant and not to make any demands (whether for information or otherwise) which may delay busy professionals in their care for other patients.

After a 40-year career as an Intensive Care Unit / Emergency Department nurse clinician and academic, Dorothy Kamaker has trained as an independent patient advocate. She uses her knowledge, skills, experience and network to navigate, negotiate, collaborate, plan and intercede in her client’s health management with one very clear goal: to achieve outcomes that reflect the patient’s wishes and best interests.

When a patient (or their family/guardian/carer) lacks the knowledge, equanimity, neutrality, time or communication skills Dorothy can advocate for them.

Recent acute scenarios include:

· the mother of a 2-week old baby, who struggled to have her child’s condition recognised and subsequently managed adequately/appropriately,

· a 68-year old man whose surgeon refused to see him in a timely manner to assess his complaints about post-discharge wound complications which, when assessed, necessitated readmission for two weeks,

· the daughter of an elderly lady in ICU who panicked when the treating doctors began to disagree about treatment options, and

· a 93-year old lady with terminal lung disease whose wish to be allowed to die was dismissed out of hand by her doctors.

Advocating for best practice care for the elderly in their homes, in hospital and in nursing homes has become a growing area of need. In July 2015 the NSW Government made a “fundamental change” in the delivery of health services to the aged (http://healthconnex.com.au/hot-topics/consumer-directed-care-(cdc)) to prioritise “more control to the care recipient, allowing them choices about care types and service delivery”. The mission statement promises choice and empowerment. Observation and anecdotal evidence suggests that implementation of this fundamental change by aged care providers has been less than impressive and many recipients of care are being charged more and receiving less than they did prior to the 2015 ‘changes’.

Increasingly, nursing home care has come under the spotlight drawing attention to the explosion in numbers of residents suffering from dementia, pressure on staff mix and ratios and myriad scandals making the news. But, as with the US, statistics on iatrogenic deaths and injuries, it is generally accepted that for every proper complaint that sees the light of day, nine are unreported, concealed or otherwise not dealt with appropriately in the interest of the resident.

For many, their time of greatest medical need will coincide with their time of least capacity to cope, to assess and to decide what reflects their best interests and wishes. With optimal outcomes as the sole goal and the patient’s wishes foremost, Dorothy Kamaker provides a service that makes the difference.

Dorothy asserts that it is an open secret in healthcare that patients with strong advocates (health professionals or articulate children or friends) have very good outcomes. It is Dorothy's goal to provide that level of advocacy.

Dorothy's experience is in both the public and private health sectors in New South Wales (St Vincent's, Royal Prince Alfred, Royal North Shore & Mona Vale Hospitals) and in Europe. Dorothy also has substantial experience conducting post graduate Master's degree courses for Critical Care nurses at Sydney University. Dorothy has particular expertise in Acute & Chronic illness, Critical & Emergency Care, Aged Care, Alzheimer's Planning, Support for work related injuries & claims, case management for general health care, aged care and Guardianship clients.

T: 0421 011 430

E: dorothy@patientadvocateS.com.au

Non-Practitioners: You are welcome to attend and participate in discussion at this free legal seminar.

Legal Practitioners: This seminar is in the Professional Skills stream / Barristers’ Skills strand and is worth 1.5 CPD points.