Aged Care & Rehabilitation Clinical Services Plan 2007 – 2012

Aged Care & Rehabilitation Clinical Service Plan 2007 - 20126.2.2 Aged Care Inpatient ConsultationGeriatricians provide consultative services for many older inpatients admitted by other services.Inpatient consultations are available in most SSWAHS acute hospitals; however the level ofcoverage is dependent on the staffing situation at the time and other available resources.Consultations are provided to patients managed by all relevant medical and surgical sub-specialties,particularly with regard to the management of geriatric syndromes, assessment of rehabilitationpotential with a view to accepting transfer of care, assessment for residential level care, and thefacilitation of discharge planning and transition to community care.OrthogeriatricsOrthogeriatric care is a key area of inpatient consultation, however the level of service provided isdependent on the settings and systems at each facility. In hospitals in the east of the Area,Memorandums of Understanding have been agreed between geriatricians and orthopaedic surgeonsto facilitate the timely provision of consultative services to patients with defined characteristics. Thisservice is best developed at CRGH where there is a significant commitment of Geriatrician andRegistrar time to its function, a model consistent with the Australian Society of Geriatric Medicine’sPosition Paper on Orthogeriatric Care. Bankstown-Lidcombe Hospital has also developed anorthogeriatric service.2005/06 ActivityData on aged care inpatient consultation for 2005/06 is not available consistently across the Areaand as such, has not been reported.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, on EDs;• 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;• Specialty skills – aged care clients in non-aged care wards do not have the benefit ofspecialised aged care nursing and allied health skills. These need to be developed to improvethe appropriateness of care provided to older patients and to reduce unnecessarily long lengthsof stay;• Interpreters – in some language groups and at particular times, there is unmet demand forinterpreter services. Without timely access to interpreter services, hospital lengths of stay canincrease; and• Data collection and management – there is a need for standardised data collection andmanagement across aged care outpatient services, to assist in service performancemanagement and monitoring. Such a system must recognise the variability in funding sourcesand reporting requirements.Projected Future ActivityInpatient consultation activity will increase in line with the growth and ageing of the population. Thenumber of Geriatrician positions should also increase consistent with this change in demographics.Future Model of CareAs the population ages, there will be an increasing demand on acute hospital services from agedcare clients. Not all this demand will be able to be met directly by acute aged care units. Whereappropriate, patients will be admitted under the relevant sub-specialty for their primary diagnosis,with consultative support from geriatric medical staff.Recommendation – Aged Care Inpatient ConsultationDevelop the capacity of aged care inpatient consultation services, consistent with populationgrowth and ageing, whilst strengthening the capacity of non-AC&RS wards to respond to theneeds of older people, people with a disability and their carers6.2.3 Rehabilitation Inpatient Consultation ServiceAn inpatient multidisciplinary rehabilitation consultative service is provided at all acute hospitals,though to varying degrees, depending on availability of staff and resources. This service providesPage 55