New research raises questions about transition care program.
The transition care program has not achieved its goal of improving the flow of older people moving between hospitals, community and residential sectors, new research has found.
The study linked, for the first time, data from all sectors including hospital and aged care places, both flexible and mainstream, across Australia at the ACAT regional geographical level.
The study, led by Dr Lynne Giles of Adelaide University, and including Professor Len Gray from Queensland University, was published in the November issue of Australian Health Review.
The first 594 transition care packages were allocated across Australia in the 2004-05 financial year, with 913 packages allocated in 2005-06 (the study period). The government aims to have 4000 places by the end of 2011-12.
A data analysis as at 30 June 2006 showed a marked variation in the distribution of acute and sub acute beds, compared with a more even spread of aged care beds.
The distribution of transition care beds was uneven, with “no evidence of coordination in the allocation of hospital and aged care services between the Commonwealth, state and territory governments”.
There were “profound differences” in the proportion of specialised beds allocated for the care of older people across Australia, and “substantial imbalances in the provision of acute and sub acute services within and between states and territories”.
“There was a weak relationship between the allocation of transition care places and the distribution of health and aged care services,” it found.
“The transition care program has not redressed inequities in the distribution of services, especially in rural areas where it appears to offer particular promise. It is unlikely the program will be sufficient to address the needs of the rapidly growing population over 80 years of age,” the study said.
Although the study was a snapshot in time there is no indication that the rise in the number of transition care places under the current government will necessarily improve the distribution of places to more closely align their placement with need.
“More work needs to be undertaken at both tiers of government to correct the uneven distribution of transition care places nationally, which should involve a more transparent process for the allocation of new places,” the report concluded.
However, the greater priority is to work with state and territory governments to address the marked geographical inequity in provision of acute and sub acute care hospital beds for older people, it said.
The findings demonstrate the importance of an integrated approach to optimise the delivery of health and aged care services. If population-based planning benchmarks of the ideal number of rehabilitation beds for older people could be developed in tandem with the expansion of the program, greater effects on flows across hospitals and community and residential sectors would be likely to occur.
The Giles research complements ‘The national evaluation of the transition care program’ report by Commonwealth and state officials, completed in May 2008, which looked at data for the same period. It found the program “provided additional treatment and care options following hospitalisation that were highly valued by patients and their families, and resulted in functional improvements”.
Along with the Giles research, it noted the “widely variable access to rehabilitation and geriatric hospital beds”. It remarked on the lack of prioritisation in the allocation of the first 2000 transition care places.
The findings of the two studies suggests that a review of the transition care program might be worthwhile in the near future. It could consider equity of access, value for money, appropriate targeting, the role of the program vis-a-vis inpatient geriatric and rehabilitation and centre based rehabilitation, which could now be addressed with the growth of the program.
Nevertheless, the program’s aims of linking services and enhancing subacute services are relevant in terms of cost containment and should find resonance with the government as it considers the final report of the National Health and Hospitals Commission.Do you have an idea for a story?
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