THE term “aged care” currently encompasses too many different aspects of care — from a clinical perspective it makes more sense to talk about long-term care for those patients requiring residential aged care.
Nearly all elderly residents of high-level long-term care facilities have some disability and have more than one advanced chronic illness. The majority have severe dementia, and many are in the palliative phase.
These residents need expert health care, not just accommodation and personal care.
An Australian Institute of Health and Welfare report shows that in 2008‒2009 almost 10% of 1.1 million hospitalisations for older people were for people already living in long-term care.
However, old people with dementia and residents of aged care facilities are not very welcome in our acute hospitals. They become increasingly unwelcome the longer they stay as “bed blockers”. In fact, I have come to the conclusion that the main business of hospitals is clearing beds.
Aged care assessment teams and social work departments are put under great pressure to get people out of hospitals. When I set up one of the first regional assessment teams in South Australia, when the system was first introduced in 1997, I would preach that the role of our team was to find the best care and accommodation option for the people we assessed. I don’t believe that this is true any longer.
As I have previously argued in MJA InSight, aged care services are outside the state-run health systems, and changing this at a structural and political level would be a monumental task.
However, this does not mean that we have to wait for a miracle to happen.
We run hospital in the home (HITH) services. A nursing home is a home, irrespective of which bit of government funds it.
If high-level long-term care facilities were supported to provide hospital services using the same model as HITH services, many of the issues that result in hospital admission could be avoided, to the benefit of the patient.
Rather than admitting a nursing home resident to hospital, a system could be devised whereby investigations could be done urgently and the resident returned to the facility, to be attended by a service similar to HITH for their actual care. This would make earlier discharge possible, especially if specialist-led services could be continued in the aged care facility with input from additional nursing and allied health staff.
If we add regional geriatric services to offer a continuum of services, rather than geriatric units or departments in hospitals, geriatricians could provide specialist support to GPs, who are currently given very little help with managing very complex and difficult long-term care of aged patients.
A number of years ago I had an excellent arrangement with a non-government organisation (NGO) that had established a new residential facility in our region, where respite admissions were treated as rehabilitation admissions. The facility had the rehabilitation space and allied health staff, and I contributed my time and clinical skills to provide an active service to our mutual client population. This offered much more than an often-resented temporary change in accommodation.
Alas, the experiment failed because the funding authority felt that it was outside the NGO’s province and did not meet the requirements of the funding model.
Yet, it shows that it is possible to make miracles happen.
Dr Ludomyr Mykyta is a consultant geriatrician based in South Australia.