Wednesday, February 25, 2009

Step Up - Step Down: sub-acute care in the ACT

The ACT is currently involved in large scale clinical redesign and health service planning to underpin an ambitious capital works program. The Capital Asset Development Program (CADP) will cost $1B over the next decade. It includes a new women and children’s hospital, neurosurgery operating rooms, refurbishment of existing community health centre and construction of one in Gungahlin and a Cancer Centre of Excellence. HCCA is involved with the health service planning and the CADP, supporting consumer representatives on high level committees holding consultations and providing consumer perspective on documentation.

This development process is seen by HCCA as an opportunity to shape our health system so that it is more consumer centred and overcome a number of longstanding problems. One such problem is inadequate provision of sub-acute care.

Sub-acute care includes rehabilitation, transition care, geriatric evaluation and management and can precede or follow hospital admission. I was pleased to see the NHHRC acknowledge the importance of sub-acute care, describing it as “the glue that connects acute care provided in hospitals with community care provided in peoples homes” (p 146 ). Their Interim Report also states that the limited provision of subacute care represents a significant missing link in the care continuum (p 146 ).

A number of our members have shared their memories of visiting relatives in convalescent hospitals after surgery or illness. This was before the closure of those facilities and the move to community based services. I think we lost something in this process and we are currently working with a group of committed consumers and carers, who consider that aspect of convalescent hospitals are needed to complement the acute services and primary care. As one consumer described it:
“It will all boil down to getting people back on their feet (as it were!) and into their homes with the minimum of trauma.”
Traditionally much attention given to sub-acute facilities has been to ease the burden of bed block. In most cases this has involved moving older patients to transitional care rather than occupying higher acuity (and costly) hospital beds. This was a driver in the establishment of a small public convalescent care unit (nine beds) in the ACT in 2002 post discharge from hospitals consumers were admitted to this unit where they are supported o regain daily living skills through personalised programs. They could stay there for up to two weeks before returning home. Sub acute care facilities such as these can improve the transition process from hospital to home and embed linkage between the acute and community sectors of our health system.

There is further consideration of sub-acute facilties on the ACT at the moment. This discussion is taking palce with regard to the Aged Care and Rehabilitation Services Plan. The plan will be released for consultation in around a month.

We would like to see further exploration of sub-acute care as an extension of primary health care, rather than acute care. The development of the “step-up” concept has been strongly supported by our members, especially those living with chronic conditions. This would enable consumer to receive a high level support in the community to keep them out of hospital. This care could be provided by multidisciplinary teams, including a range of care assistants, and there is potential to work with general practitioners to include them in their supervision of clinical practice.

The NHHRC is to be commended for their call for targets to be set by June 2010 to increase the provision of sub-acute care. This is a good opportunity for consumer movement to articulate what we need from sub-acute care so that it meets our needs for step up and step down. We think the answer lies in reframing sub-acute care as an extension of primary care rather than the traditional model tying it to hospitals.

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