Gap between aged and acute care highlighted

Aggravation felt in acute sector arises from ignorance, expert says. By Megan Stoyles.

There is a widening rift within Australia’s system of older person care between acute medical care and parts of the aged care system, according to ageing expert Professor Leon Flicker of the Western Australian Centre for Health and Ageing.

Commenting on the recent position paper Older persons in acute hospitals awaiting transfer to a residential aged care facility by the Australian and New Zealand Society for Geriatric Medicine (ANZSGM), Flicker said this tension was not due to ageism - despite the use of the term ‘bed-blocker’ within the acute system.

Acute hospital clinicians who insist on premature discharges from the health system “are responding to what they feel is required in the best interests of all patients,” he commented in the Australasian Journal of Ageing.

“They perceive needless use of high demand acute hospital beds by patients unable to benefit from these resources.”

Fricker said that both systems maintain over 95 per cent bed occupancy. “Even in the best resourced and integrated system a short delay to restorative care is inevitable...and in some under-resourced or poorly functioning regions this can be prolonged.”

The aggravation felt in the acute sector also “arises from ignorance. Comparatively few non-geriatric specialist clinicians have any idea of the intricacies of the care pathways, not only required by disabled older individuals, but by the system itself. This ignorance is further perpetuated by misunderstandings of recently appointed hospital administrators and short-term blame shifting by some health department administrative staff.

“These groups present a considerable educational challenge to explain the nature of the common conditions and syndromes of older people, the often prolonged recovery from acute illness and the additional time that multidisciplinary assessment and rehabilitation necessitates.”

Further, indifferent training at both undergraduate and postgraduate levels results in their relative incompetence to manage the most frail and vulnerable patients in clinical practice.

Flicker said the Productivity Commission had “not much really to say other than we have a system with many advantages over other countries, but there are some specific issues which now need to be addressed to allow the system to achieve its full potential.”

As examples, he cited making sure that all hospitals are age friendly, smoothing the transition between acute care, subacute care, community care and residential care and making sure that the capital and recurrent costs for residential care are appropriately managed.

Although, he said it sounded like a ‘wish list’.

ACSA acting CEO Pat Sparrow said the aged care sector had an important role to play in facilitating older people’s well-being, thereby reducing the risk of hospitalisation and managing restorative care for people discharged from hospital.

“Enabling residential and community aged care providers to deliver an increased range of services would extend the assistance available and lead to more positive outcomes,” she said.

“The specialist services already provided by residential care facilities should also be funded to provide transition care beds and supports as a matter of course. Community care services need more funding to assist with low level rehabilitation services. Day therapy centres are an under-utilised resource, with strong links to local health services; they provide a long-term restorative approach to support older people to live well in the community.

“Aged care services are distributed more widely and locally than hospital networks and offer greater potential for appropriate and restorative care,” Sparrow said.

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