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A Liaison Role in Aged Care Access Illawarra Shoalhaven ACAT Natalie Molloy, Placement Coordinator

A Liaison Role in Aged Care Access Illawarra Shoalhaven ACAT Natalie Molloy, Placement Coordinator. DEMOGRAPHIC INFORMATION. Illawarra Shoalhaven ACAT covers both rural and regional areas Area covered is in excess of 5000 square kilometres

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A Liaison Role in Aged Care Access Illawarra Shoalhaven ACAT Natalie Molloy, Placement Coordinator

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  1. A Liaison Role in Aged Care Access Illawarra Shoalhaven ACAT Natalie Molloy, Placement Coordinator

  2. DEMOGRAPHIC INFORMATION • Illawarra Shoalhaven ACAT covers both rural and regional areas • Area covered is in excess of 5000 square kilometres • Approximately 3500 community ACAT assessments and 1000 inpatient ACAT assessments conducted each year • 4 local government areas, 9 public hospitals, 4 private hospitals, 3 satellite ACAT community team locations and approximately 3300 residential aged care facility places are contained within the Illawarra Shoalhaven ACAT boundaries

  3. AREA HOSPITAL MAP

  4. NATURE OF THE PROBLEM • In 2004, it was identified that the time clients were waiting for placement into RACFs was impacting on access to the overall inpatient bed base. • On average, inpatient clients were waiting 25 days for placement, and community clients were disadvantaged by inpatient clients receiving additional advocacy and priority. •  A review of systems and processes highlighted that poor communication and collaboration across the health sector contributed to an environment where the placement of patients into RACFs was complex and inequitable. • There was a need to establish a system where consumers from both the hospital and the community requiring immediate placement were given priority and access to an appropriate facility.

  5. EXTENT OF THE PROBLEM Census and DoHA annual report data from 2004 – 2008 for NSW demonstrated that the area was particularly disadvantaged. • A comparatively low percentage of Residential Aged Care beds allocated to the region (based on aged population per 1000 people over 70 years) were fully operational. • The region had consistently maintained the lowest ratio of allocated to operational RACF places in NSW over four concurrent years. Table 1: Percentage comparison of Operational Residential Aged Care Places by region per 1,000 persons Aged 70 and Over (per financial year)

  6. EXTENT OF THE PROBLEM The 2006 Census data indicated that: • The area had an above average percentage of people eligible for aged care services.16.8% of the population in the Illawarra were persons aged 65 years and over, as opposed to the Australian average of 13.3%. • The median age of persons in the Illawarra was also 39 years, compared with 37 years for persons in Australia – the area population was older than average. Process mapping demonstrated that: • Competing for the low number of operational RACF beds were aged clients in the community, 9 public and 4 private hospitals. • Social work, ward staff, community ACAT clinicians and carers were all competing with each other to secure placement. • Community ACAT clinicians were spending additional time attempting to facilitate RACF placement for their clients Cause and effect exercise indicated source of delays where staff : • were not aware of available vacancies. • were putting forward patients unsuitable for vacancies. • did not have a solid knowledge of the very complex financial aspects of entering aged care accommodation. Feedback from the aged stakeholders ,carers and the CALD community also indicated that their needs were not being considered in line with placement options.

  7. PLANNING & IMPLEMENTING SOLUTIONS The changes that occurred from 2004 to 2009 were aimed at developing a solution to this problem. Some of the changes were planned and some were opportunistically made. • In 2004 was recognised that there was potential for the further development of a liaison service to provide equitable advocacy for clients seeking RACF placement and provide a central point of access • The staffing model consisted of two Enrolled Nurses (RN Div2) who were co located with the ACAT team and the service became known as the Aged Care Placement Service • ACAT clinician focus was redirected back to core business of assessment with clients needing ongoing care being referred to the placement service for assistance • By 2005, significant change was beginning to occur. Collaboration with RACFs had assisted in resolving many issues and trust between the organisations was developing.

  8. PLANNING & IMPLEMENTING SOLUTIONS The establishment of the liaison service which case manages the client from ACAT assessment to the point of effective referral (RACF placement secured) has resulted in improving the overall journey for clients, their families and carers. The principles developed in consultation with aged care stakeholders are still in use today and include ensuring: • Timely communication processes including sms and email for vacancy notification • Regular RACF / Aged Care Placement Service / ACAT / Acute Care meetings occur • A client focus is maintained so that outcome is not affected by bed management pressures • The placement service maintains independence and empowers clients to have choice

  9. PLANNING & IMPLEMENTING SOLUTIONS • CALD, indigenous and socio-economic factors are supported and “clustering” of CALD and indigenous backgrounds occurs • The support of hospital social workers is maintained • Attendance by placement staff at ACAT, ward and family case conferences • The development of systems to support and guide consumers / carers from decision to discharge • Post placement support is provided to people using the service including family and carers. This includes having the option to arrange transfer if necessary. From 2005, the placement service has continued to have strong support and now provides case management and aged care access liaison for both for high and low Residential Aged Care Accommodation across the area.

  10. OUTCOMES & EVALUATION • Over a 5 year period (2004 – 2009), this project demonstrated a significant reduction of 76% in the average time that inpatients waited to access RACF accommodation at the point of discharge from hospital. • This represented a decrease on average from 25 days to 7 days. The graph to the right shows data from the Annual DoHA Census of older people in hospital waiting aged care placement. It is clearly evident that despite initiatives and new programs in the region, such as transitional care, numbers of older people requiring placement from hospital are continuing to increase in the Illawarra region. Despite these increases, the placement service was able to achieve significant reduction in length of stay.

  11. OUTCOMES & EVALUATION SESIAHS Southern Hospital Network – Illawarra Average number of hospital days consumed per patient (annually) waiting for Residential Aged Care Placement 2004 – 2008 (inclusive) SESIAHS Southern Hospital Network – Illawarra Number of patients placed (annually) into Residential Aged Care directly from hospital 2004 – 2008 (inclusive) • The graphs above demonstrate the 73% improvement in average days waiting for RACF accommodation was achieved in line with a corresponding 45% increase in the number of patients who required residential beds (2004-2008 inclusive)

  12. OUTCOMES & EVALUATION • In addition, the following outcomes have been achieved: • 100% of referred clients, their families and or carers have been involved in the choice of RACF which includes consideration of their cultural and financial needs. • 100% of referred clients had the option to visit an appropriate range of facilities prior to placement to assist in informed decision making. • 100% of local RACFs, the 9 public hospital and 4 private hospitals have routinely referred to the service for liaison and placement assistance

  13. SUSTAINING CHANGE The Aged Care Placement Service has established itself as an integral part of the acute and community aged care continuum within the area. The service ensures its sustainability by: • Support within the Aged Care, Community Health and Chronic Care Stream and close alignment with patient flow. • Permanent employees providing the service. • Considering options for succession and leave relief to ensure the service remains viable. • Providing the senior executive team with timely outcome data to assist with informed decision making. • Monitoring the overall patient satisfaction through the patient journey stories.

  14. FUTURE SCOPE The placement service will embrace the challenges of an ageing population and ensure its future through: • Closely aligning the model with the Acute to Aged Related Care Service (AARCS) and being recognised at a state and area level as a model of excellence • Attendance at NSW Health quarterly benchmarking meetings to share ideas and learn from others. • Maintaining central access points to secure aged care accommodation which is a clear benefit to the consumer, their support network, residential aged care facilities, and supports the philosophy of enhancing the overall patient journey, and • Maintaining low average waits for inpatients and a highly cost effective service.

  15. QUESTIONS? Thank you for listening – questions are welcome. For enquiries: Natalie.Molloy@SESIAHS.HEALTH.NSW.GOV.AU

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