Hope endures for aged care, if great people stick around – in humour and truth, Dr Simon Grof is here for the long haul

Dispiriting is a word that can come to mind. For many aged care leaders, from provider heads, to clinical specialists, front-line staff and all who show up daily to keep senior care going, like thunderclouds over yonder, many have, with an appropriately dramatic sigh, wondered what shoe will be the next to drop. Whether it’s a mainstream media painting all providers as profit-mongering, or government funding being curtailed, or systems made more fractured, or worse still, seniors and loved ones believing that all professionals in health and aged care, do not care. Dispiriting hovers. Dr Simon Grof’s story, while not preventing the clouds, could be umbrella-esque, to be able to take the next step, and the one after that, in trying to bring the best to Australia’s health and aged care systems and its seniors.

Grof has been a geriatrician for some time, and it is in his experience of the positives and negatives, of the challenges and preciousness of his work that he lands what keeps him going in full view of the persistent issues. Hope is worthless if it is not couched in the realities of what health and aged care professionals have to contend with. For leaders at the end of their tether, stories such as Grof’s are gold, not because they only show the shiny, but because they hold up the cracks, to promote the work of transparency and past that, progress. Outside of the blame game, in the imperfection, hearing stories of those doing the work, is to honour the change value of the individual. The systemic elephant can be tackled, one sincere, persevering, imperfect and still learning, professional bite at a time. It’s time to pass out the spoons.

Choosing geriatrics

Grof is humorous and good-natured when it comes to how the world generally views his type of medicine, “’unsexy’ comes to mind”. It’s in the why, his decision to follow geriatrics anyway, that shows geriatrics has a very good thing going for it.

“To be honest”, Grof shares, “I think that was one of the main reasons I felt pulled towards geriatrics because it’s not ‘sexy’”.

“As I was approaching choosing my specialty, I looked around and I thought, who seems to be the happiest doctors actually? Who are the people that are really just nice people?”

To Grof, in his working environment, in the culture of the medicine he would practice, this was a matter of ‘oxygen’, “who are the people you can have a conversation with, who are non-judgmental, who are happy to list their faults?”

“The geriatricians, and probably the rehab physicians as well, they were by far and away, the best bunch that I could pick”.

While health and aged care has its fault lines, Grof will come to that, he sensed foundational strongholds that meant the centre would hold. And for quality care of seniors, struggling to receive the funding it needs, the centre has to be located elsewhere. Constituted of formidably strong stuff, Grof attests that the strong stuff is partly geriatricians that have held the line of culture.

Small systems – shaping culture

Grof had his suspicions of quality people, quietly and resolutely resisting rushed and narrow medicine, confirmed in his early years of training, “I did quite a few rotations in Melbourne, through Alfred Health when I was a junior during my training, and geriatric medicine stood out.”

“It was just having the time to get to know the older person, and listening and hearing their stories, hearing their insights, and having senior geriatricians shield me from being swept away by the pressures, just having a little bit more time to see the person. To see the person holistically.”

“I was able to see the person”, Grof notes, “not just ‘pneumonia in bed 7’ or ‘heart attack in bed 12’, trying to see everything, the medical need and the person.”

From those early days to now being one of the senior doctors himself, Grof experienced the old guard holding firm, to teach the new what should and could be prioritised for good medical care. At a small scale, within Alfred Health, Grof was able to see the power of the system, by professionals, on a small scale but it existed and changed lives nonetheless. It changed his life, and how he has committed to practicing his geriatric medicine.

“I was able to see that the practice of geriatric medicine was best done dealing very closely with patients, and I think what we do is mainly about the art of communication rather than the art of medicine”.

Far from dismissing the importance of clinical excellence, Grof understood how it was to be best expressed, through seeing communication as the vehicle that would land medicine brilliantly, “most of what I do is really just the old terminology, the ‘soft skills’”. But Grof doesn’t stop there, it is here he pushes and challenges.

“Calling it ‘soft’ is dismissive and I think rubbish, that terminology is judgmental and making it lesser, being able to connect with a patient, being by their side is great medicine.”

Calling a spade a space

“Health services, and how I view it, hospitals, they’re perfect for what they were created for”, Grof assesses, “acute care, the coming in with, whether young or old, chest pain, or an infection, getting treated and going home.”

“But we’re 30 or 40 years later, and our health services haven’t really adapted, particularly the hospitals so much, where now we’ve got more older people, more chronic conditions and much longer recovery times.”

Grof echoes what many heart-felt, long term doctors understand, it is not a question of bad or good but function, “the system is set up for that acute service-based review.”

Hospitals at their core were not made for long-term stays, “the environment is pretty bland, it’s not great how we operate, particularly for older people and also for younger people.”

He holds up great examples where improvements have been made, “you go into the Royal Children’s Hospital in Melbourne or Monash, and they’re beautiful wards and things like that, donated money has been able to go into improving these areas.”

But he names the reality, that he and his patients have to wrestle with, “then at my end, there tends to be less donated money to improve, you’ve got these kind of sub-acute places where older people, after their hospital stay, after a fractured hip or something, they go to these recovery rehabilitation centres.”

“And sometimes, seniors are still sent to these WWII type buildings, with four people in a room, curtains dividing up beds, no privacy.”

Grof names a fault-line, “I think modern hospitals are not really made for particularly older people, needs have changed, they’re also staying there a bit longer than traditionally they did.”

As he treats and listens to seniors and family members, Grof has a medical and personal eye on how that care is landing. The environment of hospital is not ideal to recovery, he has seen clinically but also in the dimming of the eyes, the person. Changing the overall system will take time but Grof shows that bearing witness is a critical individual step medical staff can step into.

Broken channels

Grof also names a key problem facing professionals trying to provide consistent care through multiple channels, the broken information chain, “between primary care, hospital services, aged care, and home care providers, the models of information aren’t well made, they don’t talk well to each other, there’s a lot of fracturing.”

“There’s not a lot of interoperability between systems, hospitals still use faces sometimes to get to GP clinics, I tell some of my colleagues, and they just laugh, it’s crazy.”

Grof has himself, and sees many in his orbit going the extra mile to meet these fractured systems, “people are doing their best in health but there seems to be a lot of workarounds”. Advocates and industry leaders saw they shouldn’t have to. Care should be first, not chasing the latest medical charts.

“In aged care, I think, we’re just a bit slower in some other industries in rolling this stuff out, and whether that’s, ageism, ‘oh, the older people don’t need it’, whether it’s because it’s an afterthought, whether because the royal commission came, a little bit too late (I’m glad it happened), whatever it is, what remains is the truth aged care professionals are working in, it’s a challenging space.”

It’s not a solution but it’s saying ‘I hear you’ and ‘you are not crazy for being so incredible tired’, Grof names the slog, “I feel for the workers in the hospital setting, I feel for the workforce in the residential aged care setting, the GP’s in primary care trying to put everything together as well.”

From government leaders, both federally and state, oversight is needed. For countless advocates and doctors like Grof, the discussion of funding, to the detriment of all else is short-sighted and damaging. There is more overhaul needed than just money, more that needs improvement.

With longer lives and longer stays in hospital, to greater moves between home, ward, GP visits, ward again, and residential aged care, an overhaul of communication is required Grof attests..

“We need someone to just take a step back and update the system to follow and manage people individually as they careen between different wards, a system to support that kind of transfer of care between 3 or 4 different teams.”

“All of us in the health services need to try and make it a bit more seamless”, Grof shares, “to make it a bit easier for seniors to navigate different care settings and not have to repeat their story 3 or 4 times because they’re meeting different people.”

“It’s a challenge but people are trying their best, it’s not a people problem, it’s a system problem”.

Starting change

As he progressed through his career, Grof saw opportunities to make changes, individual and small but they were made and they had impact.

“With my skills in medicine and the ‘soft’, I was then able to make what I initially thought were very small changes.”

He shares, “I would approach patients, suggesting adjusting taking a tablet off their regimen, or, we can give them a little more fluid, I saw that could make a huge quality of life difference for the older person, their family as well.”

With taking the time to hear stories, it wasn’t just his patients he got to know but family members as well. This opened Grof’s eyes to the dynamics and effort that is playing out across thousands of families across the entire country. Thousands and thousands are informally caring.

From the government, to aged care professionals, it is vital Grof shares, to understand the monumental reliance the system has on informal carers, “the system would fall apart without the partners, particularly without the daughters, giving this informal, low, or not-paid-at-all, care for people, who would otherwise be in residential aged care.”

“Seniors want to be at home, we must honour and work with how that is really managed, with the family support.”

Working with families, treating holistically and carving out the time to do so, Grof’s cup is filled, “I just love that about the medicine.”

When it comes to systemic safeguarding, Grof is also aware he is a part of a chain, he has learnt, so much he reach back to support those coming through, “from the good work-life balance, to championing good communication, patience with vulnerability, taking the time with people, all these things are great, I want to share that.”

“Hopefully I can then put forward some of my skills and learnings to the newer enthusiastic people coming up.”

Transparency in mistakes, failure shapes improvement

There is some truth behind the headlines, there are human failures in aged care, but Grof advocates for a changed attitude both from internal professionals, government and societal buy-in.

To know what needs to change, for deep and transparent reviews about what is broken, he upholds health professionals who have led with, “we’re not perfect, we’ve made mistakes, we’ll own up to that, and let’s look at what systems are failing us all.”

“There is progress, the blame game is not happening so much anymore, and the majority of the time it’s not a personal issue, it’s a system issue.”

Grof shares, “when mistakes do happen, in Victoria, we have the statutory duty of candour, and being very transparent to both our patients and family members when things happen, this supports trust and good care.”

Willing and proactive truth is vital to improving aged care overhaul Grof shares, “as professionals we’re getting better at admitting the times when we’re not great, and this has meant the freedom to take a breath and see what the bigger solutions that can assists us can be, what the changes at scale can be, because if one health service or aged care provider is having these issues, surely other people are as well.”

Far from ‘take down’ the provider or professional, the tone of improvement has importantly changed.

“We’re just trying to get that common learning and that continuous improvement, just to make it better for the people we’re serving.”

Supporting the risk of innovation

Working as a sector, government, nation, to champion trying to fix issues, means supporting medical staff if and when they fail in trying something new. Trying to pursue innovation and system change, is health for the ecosystem, “and if we do then fail [in innovating], then we’ll learn from that and give other people within the system to then have the ability to try and fail in trying to find solutions, because they know they have the backing of the senior people in health and government, ‘then I can give trying solutions a go’”.

Grof shares, “people don’t’ have to do something huge, to try and bring change, but they can say, ‘I can do the small increments and just try’”.

“Having that transparency and openness, and authenticity with patients, who we’re here for, it always comes back to the older person, saying, ‘we’ve tried this, or we weren’t able to do this’, ‘just give us a little bit more time and patience, ‘we’re trying to chase this result for you’, being open when things are broken, or when you’re trying something new.”

And he’s found out, in doing this himself, seniors are here for it. Giving them the benefit of the doubt, to be honest with systemic failure, with personal failure in trying to provide best care, “I think people are pretty understanding to be truthful, that’s certainly been my experience.”

Working with fallible

In tackling the dispiriting, another insidious element to professional care can be addressed. Psychologists have long studied doctors and how the majority place extreme expectations on themselves, far above government legislation and HIPAA oaths.

Grof kindly shares insight into this and how at times, in dealing with vulnerable seniors, in dealing with death day in and day out, in simply dealing with human-beings, situations will not always be easy, understandable or have a clear answer. He shares what he has learnt through the confusing and complex, through his failures and stamina to keep going, “with my profession and in aged care, it’s being uncomfortable with the uncomfortable.”

He shares that inhabiting this space, allowing yourself as a doctor to feel and know that, at times, you don’t know what to do will be a part of being in aged care. This does not invalidate or condemn a doctor, it usually means, very likely, they’ll grow into a brilliant one.

“It’s knowing there are bigger issues, and knowing that, just because you’re feeling uncomfortable, doesn’t mean you can’t progress things, doesn’t mean you can’t talk about it.”

“[Working in aged care] It doesn’t mean you can’t be vulnerable, it doesn’t mean you can’t make mistakes. You can’t know every detail. You just do what you can do.”

Grof is hopeful, he is realistic, “hopefully, you can make small continuous improvements to make your life easier, to champion for government leaders to continue to make them happen too, to make life easier for nursing staff, aged care and hospital services, the clinicians, the executives but ultimately the people we’re serving, to make seniors lives better.”

Championing allies

Having worked with numerous providers across his practice of geriatric medicine he shares from experience, “something I think a lot of good aged care providers do is when someone new comes into their care, they try and find out their story”.

Part of uplifting the system of senior care, to be its best, is to champion the allies who are pulling in the same direction of thoughtful and holistic care.

“Good providers do put in the time for support plans, that can incorporate a person’s story, and their preferences, so they’re not just an additional number to care for, they can interweave who this person is, and how to respond to give them the best care”.

Grof has long ago left his rose-tinted glasses behind, taking the time to build support plans, comprised of a person’s story doesn’t prevent situations going pear-shaped, it helps meet them, “if things do go pear shaped, you as a professional, can try to work out the explanation, if someone is up every morning at 3 o’clock.”

“It may well be that someone’s ‘odd’ behaviour is deeply reasonable, well, they could have worked night shifts for 50 years of their life, processes that draw out that information, have it accessible for staff, supports them to understand and respond well, that information is powerful over having one rule, lights out and sleeping, for everyone.”

Allies go deeper, Grof sees that funding changes, updates to policy must hear from those providing care on the floor, in residential aged care and hospitals.

“We have to know senior’s stories, and we have to know the stories of those delivering the care, and what they are contending with”.

“There are time pressures, there is busy-ness at work, there is a limited workforce, a nurse overnight could be looking after 60 people, and they just need Marjorie to settle down, so that the nurse can cope, so it is also reasonable that professionals will respond with the easier, quicker care, than taking our time to get to know the person in that moment, or looking at the progress notes.”

Working towards progress means sitting in the uncomfortable, sitting in the tension points, when solutions cannot be extreme in one direction. Everyone has to be at the table, everyone has to share their stories to nudge progress into sustainable and well-rounded policy.

Staying power

Whether its seniors, nurses, geriatricians, care staff or provider management, each is part of the ecosystem of aged care. All of the stories and realities in this ecosystem have value in highlighting health, best function and fit.

Funding and policy must support time and sincere but fallible humans to try and do their best, and if they fail, to learn from it and try again, “to get full stories out of seniors, and carers, as to what is going to work best for their holistic care, what’s going to be a very person-centered approach, has to be a reality for all sides.”

“The conversation about care cannot be just seniors and it cannot be just staff, it’s the messy and at times uncomfortable reality, not ideals.”

To push for change that benefits all, doctors, government, seniors must be at the same table, “get the people in the same room, speaking the same language.” Tackling human and system failures means sitting in discomfort and tension points of our current systems, from hospitals, to residential care, to home care, to make progress work in reality, for everyone that wants aged care to thrive not just survive.  

Within the fault-lines, within the frustrations, Grof has found joy in his work. He is consistently impressed by his colleagues and other professionals in age care. In the imperfect and challenging, he is energised that great people continue to show up for aged care. And that may well be the secret sauce for it, great people sticking around, truthful in stuff-ups, warm in humour, staying the course to leverage all their skills to change more lives for the better.