24 MARCH 2022

It is well established that allied health services are  an important part of multidisciplinary management for chronic pain conditions, and particularly in aged care settings where up to 80 per cent [1] of residents are living with persistent pain, which can often be under-diagnosed and poorly managed.

We also know that people with chronic pain are almost three times as likely to be dispensed opioids and other analgesics medication as those without chronic pain, and we also know that chronic pain increases with age, to almost one in four adults aged 85 years and over[2].  For the 80 per cent of aged care residents [3] who have chronic pain, evidence suggests their pain is misunderstood, poorly managed or undertreated and includes the suboptimal use of analgesics[4]. Of particular concern is the prevalence of acute and chronic pain in people with cognitive decline, who are often unable to communicate their discomfort.

These figures add up to a reality which sees many aged care residents over medicated and living with unmonitored adverse side-effects. This demonstrates the lack of understanding of proper pain management skills, which directly contradicts the recommendations laid out in the National Strategic Action Plan for Pain Management. Endorsed by all Australian state and federal governments and launched last year by Minister for Health the Hon Greg Hunt, the National Action Plan notes that allied health is an important part of multidisciplinary management for chronic pain conditions.

Access to allied health care is an issue Painaustralia has long advocated for, particularly since the introduction of opioid reforms which were introduced in mid-2020. These reforms have limited access to medications and combined with the introduction of real-time prescription monitoring programs throughout Australia, it is imperative that consumers have access to allied health care, including physiotherapy services.

It is therefore concerning to hear of news reports on the weekend saying the Australian Government may introduce a new model of funding later this year for aged care facilities. This new model, if implemented, would remove the decision-making power from allied health professionals such as physiotherapists, leaving it up to aged care providers to decide if treatments are necessary. These changes could ultimately result in less allied health services, reduced quality of care, and poorer outcomes for people living with pain in aged care. 

There is strong evidence that allied health interventions are the best treatments we currently have to reduce pain and improve quality of life for people challenged by persisting pain. Evidence most clearly captured in clinical guidelines in every jurisdiction prioritise education, activity, and self-management skills as first line intervention.

It is also certainly worth acknowledging the disconnect between allied health treatments which are effective, and the treatments which are funded in aged care. This is undoubtedly an issue worth correcting. It is also essential that allied health treatments available in residential aged care facilities are well researched and backed by evidence to prioritise the safety of residents.

The Royal Commission into Aged Care's recommendations illustrates the importance of allied health care services such as physiotherapy within aged care settings. Recommendation 38 states that residential aged care should include the employment of allied health care appropriate to each person’s needs – and this includes a physiotherapist, amongst many others.

Adding to this, Recommendation 61 of the Royal Commission says there should be short-term changes to the Medicare Benefits Schedule to improve access to allied health services, to further improve access and outcomes for people living with chronic pain in aged care facilities.

The National Pain Strategy also recognises the need for high level skill and competency to deliver optimal care. This has been recognised federally by two recent national projects that specifically target elevating allied health and medical practitioner skills in order to deliver the best care to complex pain clients, such as those in aged care facilities. To move away from more highly trained and skilled health professionals to work with these patients would seem a step in the opposite direction to these evidence-based initiatives.

It is the view of Painaustralia that residents living in aged care facilities and managing chronic pain, now than ever urgently need the services of allied health professionals. We urge and encourage the Australian Government to continue to fund essential allied health treatment services and prioritise their access for aged care residents living with chronic pain.

Monika Boogs, Acting CEO