Aged Care & Rehabilitation Clinical Services Plan 2007 Ã¢Â€Â“ 2012

More documents

Recommendations

Info

Aged Care & Rehabilitation Clinical Service Plan 2007 - 20126. CORE SERVICESCore services are those which must be available locally for local populations across SSWAHS.These services are essential for the delivery of safe and timely aged care and rehabilitation services.Core services have been categorised as either community/non-inpatient or inpatient.6.1 Community and Non-Inpatient ServicesA range of community and non-inpatient services are required for AC&RS clients, includingcommunity and hospital based prevention, early intervention, support and maintenance services.The following core community and non-inpatient services are required to provide for the growingdemand from AC&RS clients.Section 6.1.1 - Centralised Community IntakeSection 6.1.2 - Aged Care Assessment TeamsSection 6.1.3 - Agedcare Services in Emergency TeamsSection 6.1.4 - Outpatient Clinics – Geriatric and RehabilitationSection 6.1.5 - Day Hospitals and Outpatient TherapySection 6.1.6 - Home Based TherapySection 6.1.7 - ComPacksSection 6.1.8 - Transitional Aged Care ProgramSection 6.1.9 - Community Dementia TeamsSection 6.1.10 - Centre Based Day CareSection 6.1.11 - Dementia Advisory ServicesSection 6.1.12 - Respite and Support Services6.1.1 Centralised Community IntakeIn the eastern part of the Area, AC&RS operated three Intakes, servicing the local areas ofCanterbury, Camperdown and Concord. Each Intake has dedicated intake clinicians and acceptsreferrals for Aged Care Assessment Teams, Home Based Therapy, Community Options(Camperdown & Concord), Respite Services, and Day Hospital services and local Geriatric specialityclinics.Research indicates that Central Intake provides an:• Informed, single point of contact for information, and a referral point for local healthcommunity services;• Improved consistency in access to information, and referral to local community services forconsumers;• Increased clarity regarding community services;• Increased clarity for GPs around the level and type of SSWAHS services;• Reduction in the number of incorrect referrals to community services;• Improvement in the quality of referral information; and• Improved consumer satisfactionThe Older Persons and Aged Care Services Clinical Redesign Project will concentrate on thedevelopment of a single access point, consistent eligibility criteria and a concise referral guide.Implementing the centralised intake model across the Area and monitoring its effectiveness shouldoccur.Recommendation – Centralised Community IntakeExpand the centralised community intake model across the Area through the Older Personsand Aged Care Services Clinical Redesign Project6.1.2 Aged Care Assessment Teams (ACAT)Although traditionally funded to undertake assessment of people to facilitate entry into residential orresidential level care, in practice, the role of ACATs in NSW has expanded to be significantly morecomprehensive. There is contention at a state and national level about whether ACATs should havea narrow or broad function in assessment and service delivery.Page 34
Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012In SSWAHS, multi-disciplinary ACAT services are provided in community and hospital settings. Ifaccessed in a timely manner, they can assist in early identification and resolution of a range ofproblems for clients, thus reducing their need for admission to hospital.ACATs provide multidisciplinary assessment of the aged care client; short term care coordination asappropriate; recommend an appropriate level of support; and provide a consultative service tohospital, specialist and primary care practitioners. ACATs may also provide assistance withprograms such as chronic disease self-management, carer support, advocacy, dementia support,community and professional education. The range of services delivered by ACATs varies acrossSSWAHS depending on locality based service management structures and opportunities which havearisen over time. The level of staffing varies depending on catchment populations, historic factorsand operating issues.People referred for an ACAT assessment are usually over the age of 70 years (or 50 years if theyare from an Aboriginal or Torres Strait Islander background). These people are considered to be the‘target group’.2005/06 Activity DataThe data in Table 6.1 provides an indication of the number of referrals accepted and assessmentscompleted in 2005/06. The rate per 1,000 people in the target group can be used as a guide to theneed for service within the population and/or the availability of service locally. Some teams do notcollect all data on inpatient assessments. This data therefore should not be used to compareefficiencies.Table 6.1 ACAT Activity – Referrals and Completed Assessments 2005/06ACAT 2003 Referrals Completed Target % of CompletedEstimated Accepted AssessmentsAssessmentsdone ment RateGroup Assess-Assess-TargetPopulationments for Target per 1,000Group targetpopulationper yearBankstown 18,514 2,160 1,802 1,615 89.6% 97.3Liverpool/21,728143.1Fairfield3,699 3,110 2,708 87.1%Camden 11,970 1,717 1,408 1,168 83.0% 117.6Wingecarribee 4,936 640 627 575 91.7% 127.0Concord 17,875 1,940 1,810 1,674 92.5% 101.4Canterbury 12,865 1,046 874 774 88.6% 67.9Camperdown 12,970 1,688 1,502 1,217 81.0% 115.8Total 100,858 12,890 11,133 9,731 87.4% 110.3Source: Aged Care Assessment Program Quarterly MDS Report 2005-06Current and Emerging Issues• The role of ACATs - resolution of the definition of an ACAT between the Australian Governmentand NSW Health is required to facilitate future planning;• Service access – waiting lists exist to access ACAT services across the Area. The length ofwaiting lists differ and are variable over time, subject to local circumstances;• Policy and Procedures – there is variation in practice across the Area;• Avoidable hospital admissions – timely access to ACAT assessment in the community mayreduce avoidable hospital admissions by identifying and arranging care for clients at an earlystage, rather than after an acute episode;• ACAT delegation – reductions in the number of staff able to function as ACAT delegates(authorise eligibility for residential or residential level care) has occurred in some areas, resultingin longer waiting lists and waiting times for assessment;• Inpatient assessment – different models of inpatient ACAT assessment operate acrossSSWAHS hospitals. Inpatient assessment processes require review to ensure compliance withACAT Guidelines. This may result in a transfer of workload from inpatient staff to ACAT staff,and may subsequently produce longer waiting lists and waiting times for communityassessments;• Introduction of new Australian Government programs and requirements - since 2003/04these include: ACATs mandated role in asset testing procedures necessary for entry intoresidential aged care facilities; increased numbers of non-target group, complex assessmentsPage 35
Page 1 and 2: Sydney South West Area Health Servi
Page 3 and 4: Aged Care & Rehabilitation Clinical
Page 5: Aged Care & Rehabilitation Clinical
Page 88 and 89:
Aged Care & Rehabilitation Clinical
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108:
show all

Aged Care & Rehabilitation Clinical Services Plan 2007 Ã¢Â€Â“ 2012

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?