Aged Care & Rehabilitation Clinical Services Plan 2007 – 2012

Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012Services have been developed and funded in different ways across the Area, with teams havinginternally mixed funding sources and differing reporting requirements.Specialist Mental Health Services for Older People (SMHSOP) funded by AMHS is a clinicalsubstream.There are designated acute SMHSOP beds located at Rozelle Hospital, with no equivalent bedsprovided in the south west. The new 30 bed acute inpatient unit on the CRGH site, within the mentalhealth facility relocating from Rozelle to Concord, will open in early 2008. Planning has alsocommenced for a new 20 bed acute unit within the Liverpool Hospital Stage 2 redevelopment, withthe unit to be colocated with the proposed new Aged Care and Rehabilitation Precinct. Theseinpatient services provide short term management of both older people with acute psychiatric illnessand people with high support needs as a result of the behavioural and psychological symptoms ofdementia (BPSD). Both Bankstown-Lidcombe and Braeside Hospitals have 'sub-acute' aged carepsychiatry/SMHSOP beds. The beds at Braeside Hospital are managed by Hope Healthcare withinthe AMHS stream. Bankstown-Lidcombe Hospital beds are managed by Aged Care.There is a need to develop acute SMHSOP beds in the south west, supported by a number of subacutebeds across the Area. The lack of specialist gazetted beds for the older patient createsaccess issues (for these patients and others). It also has significant safety implications due toadmissions from ED to acute geriatric or adult mental health beds, sub-acute beds with limitedclinical support services and interruptions to continuity of care.Longer stay ‘special care units’, within residential aged care facilities, have also been establishedthrough AMHS and NGO partnerships, with Catholic Care operating Holy Spirit Croydon in the InnerWest, and a project with Hammond Care at Hammondville in development. These services providethe capacity to assess and treat older people with severe BPSD outside of the inpatient setting, priorto transition to a more ‘mainstream’ dementia residential care unit.There are small community SMHSOP services (either within ACAT or closely linked with ACAT) atConcord, Canterbury, RPAH, Bankstown, Braeside and Camden Hospitals. A position has alsobeen funded at Bowral. These services provide assessment and community management of olderpeople with mental health disorders or dementia, with severe BPSD living independently or inresidential aged care, and their carers. These services also assist other staff in the management ofshared clients. A restructure of these services will occur in 2008.Community based SMHSOP require enhancements to provide more timely and intensiveinterventions in the community in order to reduce ED presentations and hospital admissions.Implementation should be well coordinated with the proposed Community Dementia Teams (seeSection 6.1.9) and other Aged Care services.The development of integrated specialist Behavioural Assessment and Intervention Services(BASIS) by AMHS will build on the ACAT and SMHSOP community teams. BASIS will provide astructured, integrated and intensive role in assessment and case management of older people withsevere and complex behavioural and psychological symptoms and/or unclear aetiology. In its fullydeveloped form, the BASIS model would offer integrated, comprehensive, multidisciplinaryassessment, intervention and referral.Generalist adult mental health services provide assessment, treatment and rehabilitation services toolder people with mental disorders. This will include clients with existing (prior to age 65 years),continuing or episodic mental illness, provided there are not significant age related issues impairingfunction; urgent intervention if SMHSOP is unable to provide this or if out of regular business hours;and/or patients requiring admission under the Mental Health Act or more intensive patient care. Thismay include a shared care role with SMHSOP clinicians.Further planning in relation to SMHSOP is being undertaken through the Mental Health ClinicalServices Planning process and the development of a specific plan for SMHSOP.Page 62