Commissioning medical outreach and mobile X-ray services are some of the ways Primary Health Networks could support residential aged care, providers have said.
A key issue of concern among aged care providers is the pressure they received from families to send residents to hospital for treatment, a recent workshop has heard.
Managers and staff from residential aged care facilities across Brisbane’s northern suburbs met with Brisbane North PHN late last month to explore how they could work together to create improved systems of care.
“I think Brisbane North PHN could support residential aged care better by offering an accessible outreach service,” one aged care provider told the workshop.
“It wouldn’t necessarily be a nursing outreach. I think we need medical outreach. We certainly have some very senior RNs…with acute experience looking after residents,” she said.
Aged care providers need medical support, the participant said, as facilities were reluctant to send residents to the ED where they often did not have good outcomes.
“But at a certain point we have to send them because we have no alternative,” she added.
While fractures were often the reason residents were sent to hospital, a quick poll of service providers at the workshop found none of them had access to a mobile X-ray service.
Reduce preventable hospital admissions
Brisbane North PHN aged and community care manager Michele Smith said that a common issue at the workshop was the need for strategies to reduce preventable hospital admissions.
“Part of our aim from the workshop was to gather insights from those at the coalface, to shed light on the real issues behind these preventable hospitalisations,” Ms Smith said.
Ms Smith said the workshop represented just the beginning of the PHN’s discussion with the sector.
“With significant reform happening there are lots of emerging issues and opportunities, and having active involvement with providers gives us good information that we can use to advocate for policy at the government level,” Ms Smith said.
“Our interest in aged care is not to provide services. We are a commissioning organisation, so we don’t actually provide services.
“Instead, we’re interested in achieving equity of access for clients and in the coordination of care across the acute, subacute, community, residential, and primary care sectors,” she said.
Acute sector: high impact from residential
Vicki Tilby, nurse unit manager for the Home Hospital Service at Redcliffe Hospital, said the hospital was experiencing very “high levels of impact” from the challenges the local aged care sector faced in accessing medical care for residents.
“We have over 30 nursing homes within a 30 minute travel time of Redcliffe Hospital, so that’s creating a very strong demand on the emergency department,” she said.
She said ‘Hospital in the Home’ was one way Redcliffe Hospital was working with the community sector to reduce demand, along with a residential care liaison service, “that’s targeted at doing interventions for patients in residential care facilities, so that they don’t have to come into hospital”.
“And our utopian goal would be that all the nursing homes that we support would call us first prior to calling the ambulance and we’re currently looking at models of care that we can use to promote that concept,” Ms Tilby said.
Ms Tilby confirmed it was “a very long process” to return patients to residential care facilities, once they had been admitted to an acute hospital ward, but said her team continued to work closely with the ED on proactive strategies to better manage elderly patients.
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Employing experienced (emphasis on experienced) registered nurses 24/7 in residential care facilities would be a great start.
You would also do well to look at Concord Hospital’s Aged & Chronic Care Triage program. Their residential aged care support is the best in the Sydney region, providing on-call clinical support, geriatrician services and a host of other resources to the local health district.
But you still need to have experienced RNs onsite.
I agree completely with the need for experienced division 1 nurses in residential facilities, in sufficient numbers to oversee all care. Surely people would not be in care if they did not have ill health, therefore they need nursing care.
I agree with both statements above, however instead of demeaning aged care nurses why not empower them by offering advanced practice education. Apart from x-rays to rule out fractures sometimes our older Australians in aged care may need Intravenous medications, we need to be able to deliver this medication in house. Very few aged care nurses are able to insert a cannula or maintain venous access, because they have never had to do this- we just send them to hospital because we are aged care. This would be a small step to recognise that working in aged care instead of acute does not mean we have to stop practicing at an advanced level, if we can achieve this it would be a small step in managing chronic illness and emergent infections in house. We just have to educate the GPs on prescribing. Lets be proactive and celebrate our aged care nurses, they do a great job and they deserve to be treated as professionals, so let them work to their full capacity and stop unnecessary trips/admissions to hospital.