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

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Aged Care & Rehabilitation Clinical Service Plan 2007 - 20122005/06 ActivityData on home based therapy services is collected as part of a larger data set and as such, is notable to be clearly identified.Current Emerging Issues• Hospital alternatives – the development and expansion of day hospital and outpatient therapyservices will reduce the demand on inpatient rehabilitation and sub-acute beds;• Chronic disease - with the introduction of the Rehabilitation for Chronic Disease Program inNSW, work is required across clinical streams to develop a model which can support thedemand for outpatient rehabilitation services for people with a range of chronic conditions eg.diabetes, cardiovascular disease, and respiratory disease. Frail older people are a particulartarget group for these cooperative services;• Ambulatory care – day hospitals can link closely with ambulatory care or community acute postacute care models. Further investigation is required to determine how these links can be bestmade and/or strengthened;• Workforce – there is a limited global pool of allied health staff to meet the demand for dayhospital and outpatient therapy services;• Parking – particularly at Liverpool Hospital and CRGH is difficult to access. Clients of AC&RSservices generally have mobility restrictions that make this a significant issue. Patients regularlycomplain about parking difficulties and report this as a disincentive for continuing their requiredoutpatient treatment;• Transportation – clients requiring outpatient therapy and day hospital services often experiencedifficulties in accessing services, due to their limited mobility and lack of access to public andprivate transport. Organised transport can assist in making these services more accessible; and• Data management – there is a need to improve data management to assist in performancereporting and service management.Projected Future ActivityDemand for day hospital and outpatient therapy services will continue to increase in line with ageingof the population and increasing numbers of people with chronic disease. By increasing activity,patients will be able to be effectively and efficiently transferred from the inpatient setting to receiveongoing care and support through outpatient services.Future Model of CareDay Hospital services should be provided to clients who require multiple therapeutic interventionsand are able to access centralised services. The benefits of this model to the patient includesocialisation and the convenience of access.Day Hospitals should be provided in association with hospital and community/home basedrehabilitation facilities, or in facilities with access to the range of services, infrastructure andequipment required, such as multidisciplinary staffing, food services and gymnasiums. Patienttransport must be provided to facilitate access to all day hospital and outpatient therapy services.Links with outpatient clinics, ACATs, ASET and Emergency Departments are vital to the success ofthe Day Hospital model of care.Day Hospital and outpatient therapy services should be staffed by comprehensive multi-disciplinaryteams including, but not limited to, physiotherapists, occupational therapists, speech pathologists,psychologists (neurological & clinical), dieticians, social workers and diversional therapists,alongside medical and nursing staff. These staff should work in conjunction with other staff fromhospital and community settings, particularly with regard to chronic disease management andrehabilitation, ambulatory care and falls management. Access to diagnostic services is essential forday hospitals.Recommendation – Day Hospitals and Out patient Therapy ServicesDay hospital and outpatient therapy services across SSWAHS are expanded at appropriatesites, in line with population growth and ageing6.1.6 Home Based Therapy ServicesHome based therapy (HBT) services complement day hospital and outpatient therapy services. Theyare particularly provided to people who are able to be treated in the community and who have anadequate support network but are unable to access centre based services. There are limited HBTPage 42
Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012services provided in SSWAHS, including a Physical Disabilities Team for younger people with adisability at Macarthur, and a Stroke Outreach Service at Canterbury. Many services have beendeveloped through periodic HACC funding. The HBT services are in addition to those providedthrough the Transitional Aged Care Program (see Section 6.1.8) and service a wider range ofclients. The level and nature of service in each location is dependent on a range of historical factors,including the funding amount and source. This service model is not comprehensively available.Home based therapy can prevent deterioration and institutionalisation or improve function of thepatients, depending on their individual need, and potentially prevent readmission to hospitals. Thisservice works closely with day hospital and outpatient therapy services to ensure the changingneeds of clients are met within the most appropriate service model.2005/06 ActivityData on HBT services is collected as part of a larger data set and as such, is not able to be clearlyidentified.Current and Emerging Issues• Population ageing – The population aged 85+ years will increase by almost 100% by 2016. Asthe population continues to age rapidly, there will be an increase in the prevalence of disabilityand an associated demand for home based therapy services;• Increasing rates of chronic disease – most of the older age group will experience at least onechronic condition (NSW Chronic Care Program: Phase 2). The prevalence of diabetes isresulting in increased partial foot amputations, showing a need for improved preventative andrehabilitative services;• Increasing prevalence of falls – an increase in the prevalence of falls is anticipated, at least inthe short term, as effective intervention strategies are developed and implemented. Peopleexperiencing falls require access to a range of appropriate therapy services;• Service access – access to home based services is not equitably available across the Area.This is in part due to external program funding (eg. HACC) being available to develop the servicemodel in some areas only;• Access to motor vehicles – the provision of home based therapy services is only possible ifstaff have appropriate access to motor vehicles; and• Interpreters – in some language groups and at particular times, there is unmet demand forinterpreter services. Home based services receive a lower priority from interpreter services thanemergency or hospital services;Projected Future ActivityDemand for therapy services is expected to continue, in line with the ageing of the population,increases in chronic disease and disability.Future Model of CareHome based therapy services should be provided to clients unable to access outpatient or daytherapy services, due to limited mobility and access. Benefits are that rehabilitation services can beoffered in an environment (the community setting) which provides the best context for the provisionof therapies, and enables training of family and carers in the continued provision of therapeuticinterventions. These services should utilise a multi-disciplinary model and be available to suit theneeds of clients, for example carers who are working. To be most effective, HBT services should beavailable on hospital discharge.By 2016, HBT services should be provided to residents across SSWAHS, through expansion of theexisting small services and the development of new teams located at Fairfield (Braeside) andBankstown-Lidcombe. The services should link closely with day hospital and outpatient therapyservices. The HACC program is a possible source of external funding.Recommendation – Home Based TherapyHome based therapy services are reviewed across the Area, in association with the proposedreview of HACC services, to develop a consistent model of care and to inform future servicesplanning and funding applications6.1.7 ComPacksComPacks reduce avoidable delays in hospital discharge by ensuring that short term, low levelsupport (such as personal care and domestic assistance), is available to clients immediately onPage 43
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Aged Care & Rehabilitation Clinical Services Plan 2007 Ã¢Â€Â“ 2012

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