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Welcome and Foot and hand carers

Discussion in 'Australia' started by Matt Dilnot, Oct 6, 2004.

  1. Matt Dilnot

    Matt Dilnot Member


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    Welcome to Podiatry Arena and the Australian Podiatry forum. Craig Payne has asked me to be the moderator here, so please keep to the forum rules.

    I hope these forums contribute to good discussion.

    To kick the forum off I would like to see what people have to say about the controversial issue of foot and hand carers. It has been noted at our recent conference that there was indeed varying opinions on whether the development of foot care courses was going to be good or bad for our industry.

    A significant opposition has been mounted by both the Victorian Assoc and the APodC to ensuring the training of foot carers is not in conflict with our area of practice.

    I would be interested to hear whether people feel the development of foot carers people believe is inevitable and whether they feel it goes going to assistive or antagonistic to our profession.

    Cheers,


    Matt Dilnot - Podiatrist
    Board Member - APodA (Vic)
     
  2. davidh

    davidh Podiatry Arena Veteran

    Hi Matt,
    Foot carers?
    We have a similar situation in the UK. It would seem that the NHS will push the footcare assistants through to provide cheap labour. There is already talk of them being allowed to do unsupervised scalpel-work.

    I think I'm in favour of the concept, but it must be regulated so that there are specific boundaries beyond which they may not cross. Probably easier for you than us, dictated as we are by the economics of the NHS, and a fast-growing ageing population.
    Regards,
    David
     
  3. Julie T

    Julie T Welcome New Poster

    'foot carers'

    In the past and still now demand for podiatry services far exceed supply on the Eyre Peninsula in South Australia.

    About four years ago i received funding thru RHSET (about $18 000) to provide basic foot care training to aged care workers, carers and nursing staff around the Eyre Peninsula. It ended up consisting of three whole days of training over three months..ie one day a month and was conducted in three sites.

    i had 90 registrations for this course, which reflects the recognised need for foot health in the community. This course aimed to teach workers how to cut basic toenails and provide basic footcare. All people attending this course saw foot care as PART of their role of their job. (ie they were not specifically foot carers but paramedical aides or aged care workers etc..)
    Also taught was what is callus and a corn etc..the importance of sterilisation..circualtion and neuropathy....when to treat and when to refer....basic paddings...what you can do to help the client until a podiatrist comes to town and the role of the podiatrist!! It helped improve relevant referrals to the podiatrist and hopefully ceased the gunhoe attitude of some workers who were not assessing vascular status etc beforehand.
    All participants were hungry for this knowledge and the sessions went really well.
    We have had an update day which included massage and wound management.

    Currently where i work we have a paramedical aide who will home visit and cut basic toenails of clients that the podiatry department has assessed to be of low risk..ie they can't bend to cut their nails or can't see. this includes low risk people with diabetes. If the PMA has any concerns she refers them back to me for me to treat. Ideally the pod dept reassesses these clients yearly.

    The above is my experience with basic footcare. i do not support the idea of a specific 'foot carer' position but i do support that role being within a job description of an aged care worker.
    I support the use of a clinical podiatry assistant but that is helping in preparation, tidying up and instrument cleaning clerical etc and not client treatments.
     
  4. davidh

    davidh Podiatry Arena Veteran

    That sounds about right.
    I worked a few years ago with Support Workers (in the NHS we have lots of great titles :) ) who were trained up to the level of an auxilliary nurse.
    One of my roles was to train the support worker team to cut non-path toenails, and to recognise any conditions which needed referral back to me for pod treatment.
    Support workers main role was putting elderly and house-bound patients to bed, thereby keeping them (the patients, not the support workers :D ) in the community as long as possible.
    Great idea which worked really well - there was talk of rolling it out country-wide, but I believe it was scrapped instead! :confused:
    Cheers,
    David
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    In PM News from Podiatry Management, which had a similar debate about nail care nurses to what is happening in Australia, David Armstrong wrote this:
    Full letter...
     
  6. Tuckersm

    Tuckersm Well-Known Member

    Matt, Is the issue of alternative foot carers lack of podiatrists or the cost of providing podiatry care?

    There is a definite total lack of podiatrists as there are currently only 2000 podiatrists registered in Australian (AIHW 1999). It is accepted that 6-12% of the population has diabetes, so lets say for easy sums, that 2,000,000 Australians have diabetes, and that each of these follows DA and A.Pod.C recomendation of an annual podiatry review of their foot health. Thats 1000 assessments per podiatrist, which would be approaching 50% of a podiatrists workload (Ave 200 days worked, with an ave of 10 apptiontments a day). We don't need more alternative foot care providers, we need more podiatrists.

    So what are we to do with the aged who can not provide their own foot care. Is it a responsibility of government to provide this care at the expense of investing more into podiatry? We have people with real foot pathologies who can not access podiatry services.

    Simple nail care is a hygiene activity that fits within the ADL framework, such as getting dressed and brushing ones teeth, and should be left as part of a PCA role. If they need further training to provide that care, they probably shouldn't be doing it.

    Re; Foot and hand carers. This industry has existed for a long long time. There are more pedicurists/manicurists on the high street than podiatrists. And they fit in the beauty industry along with hair dressers, why should such very normal daily living tasks become medicallised and moved to the health industry?

    The cost of providing basic foot care is often sited as a reason to introduce para professional. This is a furphy. a podiatrists working in a SRS will see 20-30 clients in 3-4 hours, and are currently well rewarded (charging around $20 per consult), but if such a model could be introduced to the public sector the cost per service would be les than $10 per service including overheads. But this would then be at the expense of people who need podiatry.

    MORE Podiatrists, not alternatives!!!
     
  7. pgcarter

    pgcarter Well-Known Member

    Dear All,
    I know this won't be popular, but why do so many pods in public health see so few people in a day or a week. I've locumed in more than a dozen public health clinics and I swear some people couldn't work in an iron lung. The efficiency of the model could be helped enormously, but I basically agree with Steve T. But maybe they don't pay us enough to work much harder, after all people see 20-30+ patients a day in private practice, but they get paid twice as much for it.
    The issue is not only about more Pods, it's about getting a career ladder that allows ambitious people to rise but still maintain clinical hours, and how to get them to go where they are needed.
    To some extent it's a question of status, money, and job change and variation over the years. City folks are just not going to go to rural areas for 44-50 grand a year. Their spouses and families give up too much for what they get.
    But I am a fan of the option....I hope to be gone somewhere before I'm too old to enjoy it. My wife just has to finish her sought after qualification so she can get a job in the country too.....
    My what a tangled web it is.
    Regards Phill Carter
     
  8. Julie T

    Julie T Welcome New Poster

    moving rural.

    good luck Phil..and good on you. I moved to a country coastal town 6 years ago and took up a community health podiatry position. Its a great thing to consider. Admittedly it was only me so i didn't have to worry about too many family changes. I did the Seachange after working for 10 years in Adelaide in a variety of podiatry settings. The main thing in a rural area is that you need to be adaptable and be a 'specialist generalist'. There have been alot of interesting cases that walk or hobble through the door. Where i work there is alot of multi-disciplinary work, working with community nurses, physios, dietitians, diabetes educators, GPs and the occassional visiting specialist. Pity we have to have the beuracracy of management!! Even so, it is hard work but i am glad i made the change. Depends where you move to there are lots of rural issues ie not enough staff, isolation etc. but i have found that there is more support beginning to occur for rural areas including more links with the university,podiatry association and city hospitals. Admittedly i get involved and feel less isolated, but one great thing is having final year students on placement and getting the occassional locum to help out.
    It is certainly an individual choice and not for everyone but good luck to you.
    If you are considering the move talk to others who work in rural areas. cheers
     
  9. pgcarter

    pgcarter Well-Known Member

    Dear Julie,
    I have regularly holidayed in Elliston over your way. What a beautiful region, I'd love to have a year or two in a place like that...in a different life I'd be living there.....having kids does limit the options a little.
    I hope you can make a full and happy life there,
    Regards Phill
     
  10. podrn

    podrn Member

    Hello there!
    I just found this most interesting discussion while searching the web. I am a foot care nurse (RN) in California and have had an independent practice for 10 years. I provide routine foot care services that include toenail debridement, corn and callous care, and patient education. I do both home and office visits. I also teach foot care nursing and have had foot care learning experiences in England and Canada.

    I was initially trained by a podiatrist and was the foot care nurse in a large health organization (HMO) called Kaiser Permenente. While in this setting, I provided the above mentioned foot care services to high risk diabetics. Needless to say, I have LOTS of opinions on this matter. There are similar concerns the podiatrists have in this country with the up and coming certification process for RN's. We will have an exam available in Jan. for nurses to take to become Certified Foot and Nail Nurses. But even if we get large numbers of nurses to enter this field, it will never be enough (in my opinion) to keep up with the demand for the need. We have a terrible nursing shortage in this country and well as a shortage of podiatrists.

    I learned of your country’s Foot and Hand Carers profession a few months ago. I think it is a wonderful concept that we should develop in the United States. We not only have the global problems of the increasing aging population and rise in diabetes, but have the compounded fact that our country’s Medicare system, and most health insurance companies, DO NOT COVER “routine foot care.” If you are blind and have no arms, it does not matter! As long as you have sensation and circulation in your feet, you are not eligible for routine foot care services. This change happened about 10 years ago. We are now suffering an epidemic of routine foot care problems in this country that is negatively affecting hundreds of thousands of our elderly and diabetics.

    The concept of a new profession that could help us curb this epidemic is very appealing. I can clearly envision this profession fitting nicely into a team of well trained and organized foot care professionals including(but not limited to) podiatrists, nurses, physical therapists, vascular surgeons, diabetic educators, orthopedic surgeons, and any other profession out there in the world that can help in this cause. I know Europe has a profession called Podology which provides these routine foot care services. I think they have a similar training program to the Foot and Hand Carers.

    I would love to see an international foot care providers association formed that would be open to all foot care professionals in all countries. If we worked TOGETHER, for the highest good of all those in need of our services, then, maybe, we can start making a significant dent in the number of preventable diabetic amputations, as well as improving the quality of life for our elderly. We need standardized protocols and procedures that we all follow.

    I will most interested to follow this thread and see how your country and your podiatrist deal with the Foot and Hand Carers. :cool:

    Laura Roehrick RN
    Santa Rosa, California, USA!
     
  11. lise

    lise Member

    We seemed to spend a lot of time in the second year of uni training to treat (not especially toenails) but corns and calluses. Although I agree that the concept of a foot and nail carer is a good idea, i don't see how a three day training session can cover what we spend three months to skill up. And although some might say that we had not had previous experience, neither have those who are now training as 'foot carers'. i agree that the need is to place specific restrictions on what they can do, or alternatively give more training

    Lise, 4th year pod student
     
  12. podrn

    podrn Member

    undefined As far as my understanding goes, the Australian course is 16 months long (not sure of their hands on component) The UK now has a Foot Health Practitioners course for lay people that is 10 months.

    http://www.collegefhp.com/The_Foot_Health_Course.htm

    The Carribean is so desperate that they have something like a 10 day course.

    http://www.moh.gov.jm/diabetes.htm

    So as foot care needs are changing rapidly, so it seems is the manner in which foot care is being delivered.
     
  13. Cameron

    Cameron Well-Known Member

    I agree with podrn

    >So as foot care needs are changing rapidly, so it seems is the manner in which foot care is being delivered.

    Post, Agenda for Change in the NHS (UK ) indicate a government determined to limit public health sector podiatry to 'at risk' and shed the pedicure into the private sector. This I believe has major implications for foot health services within the UK. A professional association/trade union with a higher percentage of membership involved in the public health sector may now have a mammoth task ahead trying to appease their membership of change, which is almost out of their control. If right the future of foot care industry in the UK likes within the private sector and it would be in the interests of the profession to consolidate all levels of foot health professional. As I have previously stated I think the UK will become more like the Australian and US systems with greater emphasis on elective care within the private sector. This will have the potential to make the private sector more competitive than it is perhaps at present within well-populated areas.

    As Phil has previously alluded to the difference in current work practice between private and public sectors is sometimes difficult to rationalise and having a guaranteed income and pension etc., more comfortable for some. To be fare, pods in the public health service do work hard too but there is complacency which some may feel has encouraged the change we now live through.


    The rise in popularity of foot and hand carers and foot health professional and foot health nurses from around the globe clearly underpins the need for these services and podiatry is unable to cater for this. Stephen, cites the dichotomy, do we have an undefended podiatry service or are there cheaper alternatives available through job creation? I think both are the answer with the latter likely to prevail. All the more reason in my opinion to agree with the Foot health nurse colleague who calls for a greater unity among foot health professionals.

    Back in the UK - if these new initiatives are accepted and implemented then change in podiatry will be swift. Whilst initial emphasis will be placed upon GP gatekeeping with more patient/consumer input, the reality of commerce will open the flood gates for market opportunities with franchised 'foot and ankle clinics', which would cover the gambit from beauty therapy to foot surgery. with foot orthoses and footwear within. Certainly as a young person entering the foot care industry today I would be interested in catching some of that business action.

    As an old fuddy duddy, I sympathise with those challenged by change, but as a pragmatist now is the time to unite and form an industry capable and able to determine its own destiny.

    Cameron
    Hey. what do I know?
     
  14. Felicity Prentice

    Felicity Prentice Active Member

    There will be a Podiatry Assistants Course run by the APodC, through the state Associations, commencing late Septemer in Victoria (thorugh La Trobe Uni). Six part time weeks of theory with 12 weeks of supervised practice. Emphasis on infection control, basic foot hygeine, handling information and communications, patient assistance and education.. all the good stuff.

    I have no poitical opinions that I am willing to espouse on this. But it will be a great course - quoth she of the ego.

    cheers,

    Felicity Prentice
     
  15. Sean Millar

    Sean Millar Active Member

    Podiatric assistance course

    Felicity,
    do who have a contact or any details of the course?
    sean
     
  16. Felicity Prentice

    Felicity Prentice Active Member

    Contact Celia Gahan at the Australasian Podiatry Association Victoria - she is the administrative epicentre. The course is initially running in Victoria (it will be a bit of a pilot program, with more polished perfromances happening afterwards).

    cheers,

    Felicity
     
  17. Tuckersm

    Tuckersm Well-Known Member

    The Pilot program running in Victoria is part of the DHS Better Skills, Best Care - Workforce Design Strategy. Updates should be posted at
    http://www.dhs.vic.gov.au/pdpd/workforce/workforcedesign.htm
    and include a number of workforce redesign issues involving various nursing and allied health groups as well as allied health assistants and Div 2 nursing
     
  18. One Foot In The Grave

    One Foot In The Grave Active Member

    If they're low risk, why would they be having a home visit?
    I'd be interested to know how many of those 20-30 people a day have had an ABI or neuro Ax in the last 12 months? Personally I find that because we are not driven by the almighty $$ in Community Health, our clients get the tx they need, not just what they can afford. I couldn't tell you the number of clients that have been new to our service but who have attended a Private Pod for over a decade and have NEVER had a neurovascular assessment completed (yes, Diabetics included)
     
  19. carolethecatlover

    carolethecatlover Active Member

    I want to do that course!!! Anybody got Celia Gahan's email adress!!

    There appear to be lots of places in UK pod courses and I emailed all of them. Need an A level. NO WAAY! Been down that particular garden path. Was told I would get into dental hygiene if I got 5 o levels at grad c or above. I got 6 in ONE year, 3 at grade a, 2 at b, and a c....did I get in anywhere? NO> turns out to be who you know, not what you know. No more study that does not directly lead to a job. Carole
     
  20. Tuckersm

    Tuckersm Well-Known Member

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