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Hospital to aged care a rare move

Study also finds two-thirds of admissions into residential aged care are permanent. 

According to a recent report, a majority of the hospitalisations that occur amongst older Australians are for people who still live in their own homes – and most will return there after release.

Nearly 91 per cent of the roughly 1.1 million hospitalisations for people aged 65 and over were for people who still live within the community, whilst only about 9 per cent come from residential aged care, according to the Movement Between Hospital and Residential Aged Care 2008–09 report released by the Australian Institute of Health and Welfare (AIHW).

The data, which was obtained from hospital and aged-care administrative records, also revealed the nature of the migration of older people into residential aged care after being admitted to hospital.

AIHW spokeswoman Dr Pamela Kinnear said understanding the migration is an important planning and policy issue.

The proportion of elderly patients who returned to their home in the community after being discharged was 83 per cent, the study found. Of all discharges, 8 per cent returned to residential care. Just more than 4 per cent of patients were moved into residential aged care or transition care. Deaths accounted for the remaining portion.

More than 120,000 admissions into residential aged care were made for people aged 65 and over in 2008¬–09, including transfers between facilities and between respite and permanent care.

An estimated 32 per cent of all admissions into residential care were via hospital. Of those admissions, two-thirds were for permanent care. The proportion of all 2008-09 admissions into residential aged care that were permanent was 55 per cent.

Of these permanent admissions, 39 per cent were from hospitals and one-quarter were from the community. Transfers from respite care accounted for 19 per cent, other permanent care made up 14 per cent and transition care programs represented 2.6 per cent.

The report recorded that 73 per cent of respite admissions were for people living in the general community and less than one-quarter were from other care.

The people involved in the migration from hospital into residential aged care had the longest hospital stays, the data showed. Single-episode stays averaged a total of 28 days in hospital, compared with an overall average of 6.1 days. Those who returned to their usual residence usually had the shortest stays.

“Some of the data really shows us that the characteristics of the people who end up going into residential aged care from hospital are the kinds of people who already have reasonably significant sorts of problems,” AIHW’s Kinnear said.

She said the people who moved into residential aged care and had longer stays in hospital were usually there for illnesses such as strokes or dementia or were in hospital for an unplanned reason.

“I guess that what that’s telling us is that the people who end up going to residential aged care from hospital are definitely the kinds of people who have these sorts of quite chronic or difficult problems,” she said.

She said people coming from residential aged care had different health conditions to people who are admitted from the community.

The most common reason found for hospital admissions of permanent aged-care residents was a respiratory condition, at 17 per cent. The most common cause of admissions amongst older Australians who still lived in their own home was a circulatory condition, at 19 per cent.

It was also discovered that aged-care residents were twice as likely to be hospitalised due to a fall, at 10 per cent, as opposed to admissions from elsewhere, at 5 per cent.

Kinnear said some of the figures were probably attributable to “the nature of the population and the sorts of medical conditions that they have, compared with the people who don’t have to be in the residential aged-care facility”.

“We have to be careful, of course, not to then say length of stay causes people to go into residential aged care.

“They are in hospital for longer, they tend to have more complicated conditions, they tend to have these sorts of difficult conditions, such as a diagnosis of dementia or they’ve had a stroke, and often residential aged care is the best destination for them once they’ve been in those circumstances,” Kinnear said.

Other predictors of admissions into residential care from hospitals included older age, being in palliative care before discharge, the state and territory of the hospital, and having a group of co-morbid conditions.

The analysis was based on multi-day hospital stays that ended in 2008–09.

The report stated that variation in regional aged-care service provision and practices might also be influencing outcomes and that analysis suggests people who move into residential respite care from hospital might do so for post-hospital care before returning home, which might also be a stepping-stone into permanent care.

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