Managing the interface between hospital, residential and community care

1
Managing the interface between hospital,
residential and community care

• Leon Flicker
• Professor of Geriatric Medicine
• University of Western Australia, Royal Perth
  Hospital

2
SummaryNeed for effective management of the
interfaces is a priority

• The provision of health care services for older
  people occurs in primary care, acute inpatient,
  sub acute hospital, specialist outpatients
  services and residential care.
• Each has separate funding models and resource
  constraints. Each interface has the potential to
  be troubled by cost shifting and poor
  communication.
• Secure funding for the major interventions, based
  on evidence, has been difficult to achieve.
• One of the basic tenets of medical care of older
  people is to direct interventions at improving
  the quality of life rather than quantity.
• The National Action Plan for Improving the Care
  of Older People across the Acute-Aged Care
  continuum offers an opportunity for governments
  and service providers to work together for the
  better coordinated care of older people, ie our
  parents and grandparents and in the not too
  distant future, us.

3
Interdependence

• If there is no capital to locate residential aged
  care beds in the inner city, the result is access
  block for the Acute Hospital sector ambulances
  circling hospitals waiting to land.
• If Acute Teaching Hospitals decide to save money
  by closing their least glamorous section, the
  geriatric rehabilitation unit, (after all they
  are tertiary teaching units and there is nothing
  interesting or intellectually challenging about
  the health needs of older people) then there are
  long nursing home waiting lists, with increasing
  frustration of those people waiting in the
  community.
• As in geriatric medicine there is a convergence
  of downstream consequences (like confusion,
  immobility, falls)
• In any one clinical situation, all the elements
  of services for older people may need to be
  involved.

4
NHDP4 An Example of Bridging the Interfaces

• This was a major initiative establishing and
  disseminating best practice for older people
• Centred on the acute hospital system, but most
  examples were across the interfaces
• For example
• DEED programs
• Shared care of patients with chronic conditions
  with GPs
• Programs to provide acute services to people in
  residential care or in the community
• Early intervention programs to avoid hospital
  admission
• GEM Units and other ways to screen risk and early
  intervention of rehab in hospital patients
• Enhanced discharge planning and provision of
  discharge services
• Falls prevention both inpatient and community

5
Methods

• The study spanned 3 states of Australia -
  Victoria, NSW and Western Australia.
• The facilities were approached first and then the
  female residents and their carers.
• 60 hostels and 89 nursing homes participated
• 1797 low level care residents approached, 667
  agreed.
• 2454 high level care residents were approached,
  953 agreed.
• Response rate 38

6
What is the State of the Residents?
AMTS and 25D were correlated r 0.23 (plt0.001)