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

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Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012To cater for this increase in demand, staffing numbers will need to be increased commensurate withthe incremental growth in activity. ED bed numbers will also need to be enhanced to cater forgrowth in the older population in each facility.Future Model of CareAn Aged Care Service such as ASET should be provided in all hospital EDs. Such a service shouldincorporate multi-disciplinary staffing, to enhance the ability of the service to respond rapidly to theneeds of the older patients, and to establish strong links with community based services. However,it is recognized that not all facilities will have a sufficient number of older people presenting to ED toprovide a full, comprehensive multidisciplinary team. As such, the size and configuration of the teamshould be determined locally, based on demand. At some sites, ED based aged care servicesshould operate extended hours (5pm - 10pm) and weekend days to capture additional patients. Thedemand for this service will need to be determined locally, subject to activity.New models to improve the care of older people presenting to EDs are continually being developedand piloted. Sydney West Area Health Service (SWAHS) Emergency Departments are piloting theOlder Persons Evaluation Review & Assessment (OPERA) Unit model, comprising a dedicated unitfor older people designed to facilitate better processes of care and improved patient outcomes. Inaddition, NSW Health is developing the sub-acute fast track elderly (SAFTE) model of hospitalavoidance for patient ages 75 years and older. At this stage it is not possible to determine theeffectiveness of these models.The Aged Care and Older Persons Clinical Redesign Project will review these models andrecommend strategies to improve the care of older people within EDs. Solutions may includestrategies such as Acute Care Triage and Medical Acute Care Units (MACUs).Recommendation – Agedcare Services in Emergency TeamsA. Expand existing ASET services to cover extended hours according to demandB. Review existing and develop new models for the care of older people presenting toEmergency Departments.6.1.4 Outpatient Clinics – Geriatric and RehabilitationOutpatient clinics may be medical, multidisciplinary, nursing, or allied health. The range of clinicsavailable varies according to site, and includes general and specialist clinics. Referrals to outpatientclinics come from a variety of sources including General Practitioners, ASET, ACAT and inpatientunits. Access to these clinics may prevent avoidable hospital admissions, enable a reduced lengthof stay through the provision of acute and post-acute care, and provide ongoing support andmaintenance. Some clinic types include wound, cognitive disorders, amputee and continence. Insome facilities, Ambulatory Care services complement the outpatient clinic role.Outpatient clinic services are provided at Royal Prince Alfred (RPAH), Concord Repatriation General(CRGH), Canterbury, Bankstown/Lidcombe, Braeside, Liverpool and Camden Hospitals, often withshared infrastructure between aged care and rehabilitation.2005/06 ActivityGiven differences in structure, function and funding sources for the various outpatient clinics acrossthe Area, and differences in data collection and analysis systems, it is not possible to portrayaccurately outpatient clinic activity.Current and Emerging Issues• Population ageing – as the population continues to age rapidly, there will be an increase indemand from older people, particularly frail older people;• Prevalence of dementia – the prevalence of dementia is expected to double by 2016.Particular expertise will be required to assist clients with dementia;• Geriatric medical workforce – some parts of the Area, particularly in the south west, have beenexperiencing difficulties in recruiting geriatric medical staff. As such, there is limited, if anycapacity to provide outpatient clinics from some facilities;• Service access – there are long waiting lists to access certain clinic types and/or particularlocations;Page 40
Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012• Service equity – different generalist and specialist clinic services are available across the Area,subject to historical service development;• Interpreters – in some language groups and at particular times, there is unmet demand forinterpreter services;• Transport – many AC&RS clients identify difficulties in accessing hospital based services.Appropriate parking, including disabled parking and safe drop-off spots are required for clientsusing private transport. Organised transport to and from geriatric clinics facilitates access andimproves safety;• Physical capacity – AC&RS clients are usually accompanied by carers and/or family membersand often have mobility aids to assist them in the activities of daily living. Clinic space mustinclude sufficient room to accommodate these needs; and• Data collection and management – there is a need for standardised data collection andmanagement across outpatient services, to assist in service performance management andmonitoring. Such a system must recognise the variability in funding sources and reportingrequirements. Improving these systems will allow clinical staff to have a greater focus on thedelivery of clinical services.Projected Future ActivityIf equity of service provision across the Area is to be achieved, and services are able to meet theneeds the target group, additional medical, nursing and allied health staff, as well as administrativesupport will be required.Future Model of CareOutpatient clinics will continue to be a core service within AC&RS, with a focus on early identificationand treatment of illness or functional decline, to prevent avoidable hospitalisation and/or prematureadmission to residential aged care, as well as post-acute care, support and maintenance. Patientsmay be referred to these clinics by their General Practitioner, ASET/ED based services, ACAT, orinpatient unit.These clinics will complement other services within the service model. They will be client focussed,offering ‘whole of patient’ care, where appropriate in a multidisciplinary model.The range and scope of clinics at each facility should be based on local demand and the localservice system, including access to medical or other expertise. An aged care/geriatrics clinic shouldbe available at all sites with an aged care medical presence. Highly specialised services should beavailable across the Area, particularly memory, falls and balance and continence clinics. Some ofthese clinics will need to be linked with other services, such as the Specialist Mental Health Servicefor Older People. A rehabilitation clinic should be available at all sites with a rehabilitation medicalpresence, and highly specialised services should be available at central locations. These areconsidered in Section 8.Recommendation – Outpatient ClinicsOutpatient geriatric clinics are established at Camden and Bowral Hospitals by 2010 and alloutpatient clinics are expanded across the Area in line with population growth and ageing6.1.5 Day Hospitals and Outpatient TherapyDay hospital and/or outpatient therapy services are provided at RPAH, CRGH, Liverpool, Braesideand Camden Hospitals. Service recipients may be under the management of either a Geriatrician orRehabilitation Specialist, or both.Day Hospital services provide a mix of medical, nursing and allied health interventions to assist olderpeople to improve functional outcomes, reduce the need for hospitalization and achieve earlierdischarge from hospital. The service is usually associated with the provision of a range of therapiesover the course of up to 4 hours, which provides opportunities for socialization and a shared meal.Transport to and from the day hospital is also provided.Beyond these basic services, there is a specialised diabetes and pulmonary rehabilitation service(Canterbury Hospital), a specialised amputee rehabilitation service (Liverpool and RPAH/Balmain), aHACC funded Community Rehabilitation and Physical Disability Team (Camden Hospital), andExtended Care Services (via Bankstown-Lidcombe and Bowral Hospitals).Page 41
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