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

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Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012due to the responsibility for the completion of the Boarding House Screening Tool for clientswishing to enter Boarding Houses; ACATs identified as one of the HACC ComprehensiveAssessment agencies under Regional HACC protocols; ACATs identified as the investigativeand assessment agency for HACC agencies in cases of suspected abuse of older people;changes to ACAT assessment requirements, including data entry, and the introduction of theTransitional Aged Care Program. These additional roles have increased ACAT workloads, andcontribute to the long waiting lists;• Access to motor vehicles - the majority of ACAT assessments are undertaken in thecommunity setting. Access to motor vehicles is essential to facilitate timely assessment ofclients and reduce waiting lists;• Interpreters - in some language groups and at particular times, there is unmet demand forinterpreter services. Work continues to be required between staff and interpreter servicesparticularly regarding diagnoses and professional separation;• Review of the Aged Care Assessment Program in NSW (BSR Solutions) – there has been amajor review of ACAT policy. It is anticipated that the review will recommend major structuralreform; and• NSW Auditor-General’s Report – Strategies are being developed to implementrecommendations in the Auditor-General’s report on ACATs in NSW (Auditor-General 2006).Projected ActivityThe need for the traditional ACAT service (assessment of eligibility for residential level care) isprojected to almost double in the future, in line with the eligible population. Assuming the averagerate of assessment across SSWAHS is maintained (110 per 1,000 people in the target group), it isprojected that 12,803 people would require assessment in 2011, an increase of 1,670 from 2005/06(based on the number of completed assessments).Taking into consideration existing waiting lists, the need to undertake assessments for peopleoutside of the target group and the increase in the 85+ year old population, a benchmark of120:1,000 people over 70 years may be a more appropriate target (see Table 6.2). To meet thisprojected need, additional staffing for all ACATs, and enhanced information and communicationsystems, will be required to develop efficiencies in the service model.Table 6.2 Estimated Number of People Requiring Assessment 2006 - 2016ACATCurrent rate 110:1,000 targetpopulationRequired rate 120:1,000 targetpopulation2011 2016 2011 2016Bankstown 2,026 2,113 2,210 2,305Liverpool/Fairfield 3,172 3,715 3,460 4,052Camden 1,774 2,291 1,936 2,500Wingecarribee 701 872 764 952Concord 2,079 2,257 2,268 2,462Canterbury 1,560 1,672 1,702 1,824Camperdown 1,490 1,645 1,626 1,795SSW 12,803 14,566 13,967 15,890Source: Aged Care Assessment Program Quarterly MDS Report 2005-06 and DIPNR Population Projections (2004)Note: Target Population based on Number of People 70+ only (not weighted for Aboriginality). Target population does not includethe number of assessments undertaken for other people eg. younger people with a disability or dementia.Future Model of CareThe activity projections outlined above indicate a need to increase the number of ACAT staffperforming traditional roles by 2016 in line with population growth, if existing service levels are to bemaintained. Greater resources will be required if the desired higher rate of assessment is offered, orif a more comprehensive model is agreed between funding bodies.The preferred model is to develop a more responsive service comprising a rapid response team torespond to the needs of inpatients, patients post discharge from hospital or ED, patients referredurgently by GPs, and residents of aged care facilities.Multi-disciplinary staffing should include staff from a range of disciplines such as nursing,physiotherapy, social work, occupational therapy, speech pathology, welfare and dietetics.Appropriate linkages should also be created and maintained with SMHSOP trained staff inPage 36
Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012psychology and neuropsychology. In addition, psychogeriatric nurses could also be attached toACAT or provided as a separate but closely linked service (refer Section 8.2).It is estimated that each ACAT staff member manages an approximate case load of 140 people perannum. This is based on a multi-disciplinary assessment service which involves staff having anactive role in the support and management of clients who are not recorded in their case load. Itshould be noted that the availability of support services in each locality will need to be taken intoconsideration in the use of these projections, with potential adjustments required based on localcircumstances.Recommendation – Aged Care Assessment TeamsAs funding permits, expand the accessibility of ACAT services in hospitals and communitysettings, including the development of an Area-wide rapid response capacity6.1.3 Agedcare Services in Emergency Teams (ASET)Given the number of older people accessing SSWAHS Emergency Departments (ED), specificservices have been developed to enhance the responsiveness of EDs to the needs of older people.This is consistent with the Framework for the Integrated Support and Management of Older Peoplein the NSW Health System. At present the Agedcare Services in Emergency Teams (ASET) is theonly ED based aged care service model in SSWAHS. As identified in ‘the Framework’, thecommunity/residential care to ED interface is a critical pressure point in the continuum of health carefor the older person and in relieving pressure on the acute hospital system. Closely associated withthis is the need for preventive community services and sound communication mechanisms.ASETs provide a rapid and comprehensive multifaceted geriatric assessment of targeted elderlypatients who have presented to the ED. This improves the understanding of the elderly person’spresentation to ED, and facilitates appropriate discharge home (by the organisation of services andliaison with primary health providers) or fast tracking of appropriate admissions. Referrals to ASETcome from other ED staff, using an agreed screening protocol, leading to a collaborative approach tothe delivery of specialized care.ASETs are based in EDs at RPAH, CRGH, Canterbury, Liverpool, Fairfield, Bankstown-Lidcombe,and Campbelltown Hospitals during core office hours. An extended hours/weekend service recentlycommenced at Bankstown-Lidcombe Hospital.2005/06 Service ActivityBecause ASET is predominantly targeted at people aged 70+ years (the main users of the service),the following data is presented for this age cohort. However, to highlight the changes which willoccur with the ageing of the population, a separate analysis of the 85+ year cohort is also included.In 2005/06, there were 277,884 ED presentations comprising 102,511 (in the east) and 175,373 (inthe south west) presentations. The distribution of presentations across the Area is consistent withthe differing demographic profiles. Table 6.3 indicates that ED presentations for people aged70+years equate to approximately 45% of the total population in that cohort. More notably,approximately 70% of people aged 85+ years presented to an ED in 2005/6.Table 6.3 Emergency Department Presentations by Zone and Age (70+ years) 2005/0670-84Est.Pop.200670-84EDPresentations% oftotal70-8485+Est.Pop.200485+EDPresentations% oftotal85+pop.70+Est.Pop.200670+EDPresentations% oftotal70+pop.pop.East 36,421 15,742 43% 7,672 5,332 69% 44,093 21,074 48%South 52,060 20,269 39% 8,780 6,153 70% 60,840 26,422 43%WestSSWAHS 88,481 36,011 41% 16,452 11,485 70% 104,933 47,496 45%Source: HIE 2007Page 37
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