Who is my mother's GP in aged care? Keeping her doctor, what to do when he stops visiting, and who decides after hours

The doctor who used to come

Your mother has been in the home for two months. Her GP of twenty-five years said he would keep seeing her, and he did — once. Since then there have been two phone consultations and a script faxed through. Nobody has told you anything has changed, because from the home's point of view nothing has: she has a GP listed.

This is the most common gap in Australian residential aged care, and it is rarely anybody's deliberate decision. It happens quietly, and by the time a family notices, it has usually been months.

She keeps her GP — and that is genuinely her right

Moving into residential aged care does not change who your mother's doctor is. She chooses. The provider cannot require her to transfer to a particular practice as a condition of entry, and cannot make that choice for her.

What the provider does have to do is make sure she can actually get the clinical care she needs. Under the aged care quality standards a provider is responsible for the clinical care delivered in its home, and that includes facilitating access to a GP and to the other health practitioners a resident needs — not simply noting a name in the file and waiting.

Those two things together are the lever. "She has a GP" and "she is receiving medical care" are different statements, and only the second is the provider's obligation.

Why GPs stop visiting

Be realistic about the cause, because it changes what you ask for. Visiting a residential aged care home takes a GP out of the practice for a block of time, involves paperwork the clinic does not generate, and pays comparatively little for the disruption — there are Medicare items for attendances at aged care facilities, but for many practices the arithmetic still does not work. Add distance, and a GP forty minutes away simply stops coming.

So a conversation that begins "why don't you visit my mother anymore" will not go well. A conversation that begins "are you able to keep attending her at the home, honestly — and if not, can you help us hand over properly?" usually goes very well. Ask him directly. Do not ask the home to ask him.

If she needs a new GP

Ask the home which GPs currently attend the facility, how often, and on which days. Many homes have one or more visiting practices, some use a dedicated aged care medical service, and some rely on telehealth after hours. Choosing from that list is not giving up her right to choose — it is exercising it in the only way that produces a doctor at the bedside.

When you change, insist on a proper handover: current medication list, past history, allergies and intolerances, what has already been tried and stopped. A fresh assessment with no history is how a woman on ten medicines ends up on thirteen. If she has a My Health Record and you are an authorised representative, check what is actually in it — the medicines list there is often the fastest way to spot something nobody mentioned.

The other people who should be coming

The GP is not the whole of the clinical care, and the services families most often miss are the ones nobody offers unprompted: dental (poor mouth care in dementia is one of the commonest silent causes of pain, refusing food and weight loss), podiatry, audiology, optometry, physiotherapy, dietetics, speech pathology, and continence assessment. Ask which of these visit the home, how often, and whether there is a cost to your mother for each. The answer to that last part is not the same everywhere, and it belongs in writing.

After hours, and the document that matters

There is no doctor on site overnight. There are care staff, a registered nurse depending on the home and the hour, an escalation protocol and a telephone. After hours the options are the GP's on-call arrangement, a locum or telehealth service the provider has contracted, and 000.

So the useful question is not whether a doctor is there at night. It is who decides, at three in the morning, whether she goes to hospital — and against what written instruction. That instruction is her advance care directive, and it is worth being precise here: the name, the form and the rules differ by state and territory, as does who becomes her substitute decision-maker if she has not appointed one. Whatever it is called where you live, two things hold everywhere. It has to be completed while she still has capacity, and a copy has to be in her file at the home. A directive in a drawer at your house does nothing at 3 a.m.

If she has appointed someone — an enduring guardian, an enduring power of attorney for medical decisions, whatever your state calls it — the home needs that document on file too, and you should check it is the current version.

Six questions to ask

1. Which GPs attend this home, how often, and on which days?
2. Who is recorded as my mother's GP, and when did that doctor last physically see her? Ask for the date, not an impression.
3. What happens after hours — on-call GP, locum service, telehealth, or straight to 000?
4. Which allied health and dental services visit, and what does each cost her?
5. Is her advance care directive in the file, and is the substitute decision-maker documented and current?
6. How will I be told about a change in her medication or a change in her condition? Fix the route, or you will find out by accident.

If you get nowhere

Put it in writing to the facility manager: one question, one date. If that does not work, two free avenues exist and both are used far less than they should be. The Aged Care Quality and Safety Commission takes complaints from family members, including anonymously, and can act on the provider. And free, independent advocacy is available to older people and their families through the national aged care advocacy network — they will help you frame the issue and can sit in on meetings with you.

Keep copies. Not because this is heading for a tribunal, because it almost never is, but because in a home where the manager changes every couple of years, the family with the folder is the only one with a memory.

Where to start

If you are still looking, "which GPs attend, how often, and what happens after hours?" will tell you more in two minutes than the tour tells you in an hour. If your mother is already in and you have just worked out that nobody has examined her since March, nothing is lost — these six questions work in writing and are almost always answered.

If you would rather not run it alone, we can. For A$109 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here

This article is for information and does not replace medical or legal advice on your own situation. Advance care planning documents and substitute decision-making rules differ between states and territories: check the requirements where your mother lives. Curalune does not allocate beds and does not guarantee availability.