Monday, November 3, 2008

Consultations on aged care and rehabilitation issues paper

Outcomes of the Aged Care and Rehabilitation Issues Paper/Options Consultation

Health Care Consumers Association of the ACT Round Table on 20 October 2008 at HCCA office Pearce Community Centre

There was a broad discussion on the underpinnings of the ACT aged care and rehabilitation services, the purpose of the plan, its context, its relationship with other health and broader government plans, coordination mechanisms and the need for monitoring and evaluation. It was throught that a preamble to the Plan should be provided to reflect those broad issues.

  • Development of specific care coordinators that look at the person as a whole – social, housing, physical health. These care coordinators must be able to cross all ACT Government Departments
  • ACT Health to develop an appropriate convalescent facility (not a sub-acute ward) that allows people to appropriately transition back to their own home and or their new living arrangements
  • Develop a spinal rehabilitation unit within the ACT
  • Increased numbers and role for Nurse Practitioners
  • Development of a single HACC funding service
  • Increased palliative care services in the ACT (new facility constructed on the south side). Services should also be able to be accessed in facilities, home or community.

Consumers at the forum also raised the following more specific aspects and issues to be considered in preparing an aged care and rehabilitation services plan.

Scope of Plan
  • The Plan needs to be realistic in terms of the planning period and resources
  • The Plan should be defined in relation to the type and range of services being incorporated in the Plan against the broader context of the other available services; public/private: ACT Health/Commonwealth: ACT/NSW needs and services: aged care services/ community based/acute care/aged residential.
  • The scoping of the Plan must also address both existing financial/funding models and those proposed.
  • How does this Plan fit within the Capital Asset Development Program and broader ACT Government uses for other assets such as closed school sites?

Planning process
  • The planning should take as its starting point existing services and structures, identification of shortcomings and positives
  • Plan should include an implementation strategy and process
  • Plan must be able to proactively interact with other Government agencies eg on local housing issues
  • Plan to identify key performance indicators for monitoring and evaluation; this requires incorporation of appropriate data collection from the start of the Plan (preferably with a starting point baseline)
  • Plan to be evaluated some 12 months prior to end of planning period.

Service philosophy

Plan must look at the person as a whole and must
  • be person centred
  • take into account the social needs of the person (not just physical)
  • take into account the housing options
Plan to incorporate the community location approach rather than locating services adjacent to hospital campus.
Plan to provide for transition facilities and support services such as step down and convalescent facilities.

Identification of needs and issues
Demography including:
  • current and projected demand based on demographic and service data
  • comprehensive data-base of current services and user outcomes
  • existing policies and plans
  • outputs, findings and recommendations from recent and current reviews eg Equipment Loan Scheme
· Identify service gaps, transitions and services
· Consult with consumers, carers, health professionals.

Service Coordination
Discontinuities between the aged care facilities and hospitals are large
Gaps lead to huge personal impact and financial impact for the individual
and the need to support families and carers
There is a distinct lack of flexibility in service providers
Need for transition facilities and services
There needs to be specific care coordinators (see ACT Government Coordination across departments below)
- a navigator model
- cost effective
- may also need to act as an advocate
Plan should outline strategies to enable proactive linkages with other ACT Government Services:
  • must be a whole of government approach that has all departments working together
  • some people don’t want services that are run by non government organisations
  • no out-sourcing of services traditionally provided by ACT health or ACT Government
  • Northside Community Service ‘burnt’ 80k and provided a very poor service
  • There are many services provided by non ACT Health service providers andhow will the plan link to other non government service providers
  • Consider a single phone number to call to ask advice and or to help

Transition services
· There is an Australian Government push to centralise access to community care – this seems counterintuitive
· Identified a preference for government service (see Northside issue)
· There is need to simplify funding and services (i.e. broader entry criteria?)

· Convalescence beds are a critical service that needs to be reinstated
- enables an appropriate level of care
- allows for the individual to practice being at home
- there were 9 beds
- sub acute beds are not appropriate
- this should not take to form of a medi-hotel
- staff must be appropriately trained – i.e. not just certificate IV workers
· Clients who require a nursing home placement but are in the hospital system
- Needs are different from a convalescent facility
- There needs to be transition facility to free up the acute bed and provide the appropriate level of care for the individual
- Currently they are scattered throughout the hospital
- They should all be accommodated in one ward (or facility)
- There are between 20 and 25 people in the predicament
· Step down facility should be investigated as integral part of this service..

· Appropriate housing is a key
- Policy regarding single person single bedroom is poor
- Does not allow for visiting carer
- Can therefore lead to increased hospitalisation
- There is much time spent finding housing for those in need
- This costs far more than modifying housing
- i.e. $1200 per day for a hospital bed versus $20,000 for modifications, equipment and services for a year
- ACT Housing houses must be built with ‘universal design’ (adaptable housing standard AS 4299) at its core
· The Plan must enable ACT Health to engage to achieve a change in the attitude of ACT Housing
- People must have the ability/power to make decisions
- Allow some people to have modification made to their houses early
- Environmental sustainability must play a role also
- All departments must report against this

Identified needs
  • Spinal injury rehabilitation: Plan should incorporate the processes needed to establish a case for ACT based specialised spinal injury and acquired brain injury units that can provide the necessary rehabilitation. Currently acute care is done well at TCH but spinal injury rehab is done in Sydney, which is disruptive stressful and expensive
  • Inability to access an appropriate equipment (loan) scheme
  • Are ‘not wanted’ by NSW health system

Palliative Care
- There will be an increase in palliative care services
- There needs to be a hospice provided on the south side
- The government should set aside land for this now and provide capital for its construction
- People want choice in services and options:
§ Community based (specific hospice)
§ Hospital based
§ Home based, with appropriate services provided to the home
- What are the projections for palliative care?
- Anecdotal evidence suggest that Calvary are not keen for a second hospice
§ Felt that there was very little accountability in the services they provided
- The group was not aware of the turn away statistics but felt that, from their experience, they were likely to be high
- COTA did some research ~ 20 years ago
§ Majority wanted palliative care in the home
· If they had a carer
· If the carer could cope
· If they were not in pain
- There is a respite service available
§ 2 beds only
§ Needs to be enlarged
§ Booked out well in advance
- Look at best practice palliative care strategies from around the world
- Review ACT strategy

Workforce issues
· General Practice
- hard to get GPs in Canberra
- almost impossible to get a GP to go to an aged care facility
§ it is expensive and difficult for them to do
§ when they are at the facility they often get inappropriate referrals (from untrained staff)
· Aged care nursing
- an issue both in aged care facilities and community care
- increased use of nurse practitioners

· Allied health care
- lack of occupational therapists is a particular issue

· How do we use workforce better
§ E.g. OT are unable to achieve the results the could because they cant access services and are doing too much administration
· Aged Care facility workforce
§ Not valued
§ Under paid – nurses are paid ~30% less than ACT health nurses
§ Under trained – many have a Certificate IV, many do not
· Community nursing
§ Highly valued
§ Must be funded
· Some OH&S requirements are silly
§ Using lifting equipment that takes one person in a home requires two people in hospital and or nursing home
§ This can prevent and delay the delivery of essential services
§ Risk framework needs to be looked at and appropriately managed

Aged care residential facilities
· Concerns
- once a client goes into the facility they lose their rights to choice
§ The facility knows what is best for them
§ Cant (always) access HACC services
§ Cant access community transport
§ Often lose the access to the community which increases social isolation that leads to further problems
- Care coordination would be appropriate
§ Facilities may chose not to be involved
§ This would leave their clients out of the loop
- What can be done to influence aged care facilities
- Recognise that many facilities are no longer profitable
§ Many more high care clients than before
§ Churches are now getting out of aged care
§ Maybe there needs to be a change in the model of care
- Is it appropriate for aged care facilities to look after older ‘high care’ clients?
- Staffing in aged care facilities
§ Under trained
§ No nurses
§ Not valued as employees – paid less than ‘someone packing shelves’
- Young people in nursing homes
§ This is in appropriate

- Two tiered system does not work well
- Too many different sources of funding
- Funding is too “specific” – too many criteria that makes it difficult to get funding and then to report on it
- ACT needs to try and influence Australian Government to simplify the system
- Would like to see HACC territory based rather than Australian Government
- Which department should administer HACC?
Other issues
· Refer to consumers and carers separately

· Social sustainability
- Key to keeping fit and healthy
- Remain connected with their community, their friends and their family

· Finance
- Against a brokerage model
§ Felt that this was just anther source of losing money
§ Need to review models that support the community sector

· Chronic Care
- Coordinated approach
- Self-care or self management
- Provide for greater levels of care

The Plan should include an implementation plan with appropriate strategies and a schedule – noting the earlier comment about the need for measurable key performance indicators.

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