Australia is grappling with an increase in hospital admissions amongst older people. 2015–16 and 2019–20Hospitalizations amongst people aged 75–84 increased by a mean of three% per yr, the biggest increase amongst all age groups.
The increasing demand is putting significant pressure on the healthcare system, contributing to poor patient flow, longer stays in emergency departments (EDs), and even ambulance overruns. This happens when paramedics are forced to attend on the hospital entrance and can’t transfer a patient to the ED in a timely manner.
In response, some health system leaders have recently called for the creation of independent geriatric hospitals to specifically meet the needs of older patients.
But is this an excellent idea? While there could also be some advantages, the decision for specialist geriatric hospitals signals that Australia is failing to supply adequate care for older people.
Geriatric care in Australia
Across Australia, geriatric care is often provided in sub-acute hospitals, specialist units, wards and clinics, following the acute a part of the hospital stay.
One path is geriatric assessment and management serviceswhich aim to enhance the functioning of patients with age-related diseases, similar to frailty and cognitive decline, following surgery or other medical incidents.
In most states, geriatric evaluation and management services may additionally be available delivered to your property.
Looking at the info from public hospitals across the countrywe are able to see that service levels vary across the state. We calculate that in 2020–21, geriatric assessment and management services with a minimum of one night’s stay accounted for 45% of sub-acute care admissions in Victoria and 20% in South Australia, but only about 8% within the Australian Capital Territory and New South Wales.
These hospital-based services take a holistic approach to assessing multiple points of an older person’s health, similar to mobility, mental health, medication management, nutrition and social support, to tailor individual care plans that help older people live at home longerwith a greater quality of life.
On the opposite hand, lack of access to community-based geriatric care – similar to home care packages – is often seen as an element that increases the necessity for specialist geriatric care in hospitals and increases the length of hospital stay.
We know that current waiting time For a level 4 (highest) package, this era is between 9 and 12 months, although the federal government has committed to shortening this era with latest reforms to aged care.
Without adequate support at home, older people often find yourself in hospital, where they generally should spend weeks or months waiting to be transferred to a care facility.
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Pros and cons of geriatric hospitals
A specialist geriatric hospital may very well be designed across the needs of older patients. It could include specialist medical and support services, but also an adapted physical environment, similar to clear signage and quiet spaces.
It is necessary to think about who will staff these stand-alone geriatric hospitals. Geriatric patients will still need specialists aside from geriatricians, so cardiologists, for example, might want to concentrate on geriatric cardiology. Alternatively, separating care in this manner could mean that geriatric patients receive lower quality cardiology care (and other specialties).
Would additional capability in a stand-alone hospital help with healthcare system pressures? The easy answer is yes, but as with adding capability to the hospital system, if this unlocks unmet demand and draws much more patients into hospitals from the community and aged care, it is unlikely to assist with ED congestion.
It is also price considering whether an independent hospital could have its own geriatric emergency department. It is unlikely that an emergency department on this context would reach the patient volumes required by emergency departments to take care of quality and efficiency. However, without one, transfers from existing emergency departments would further strain limited ambulance resources.
So would a stand-alone geriatric hospital be cheaper than spending the identical budget to construct it otherwise? By focusing on specific populations where the impact can be biggest, we could make the marketing strategy work.
Dementia Care: A Potential Target for Specialist Hospitals
Psychogeriatric care – mental health care older adults – is a main example of where federal funding gaps are failing patients. This is particularly true for those with behavioral and psychological symptoms of dementia.
Families are usually not well supported locally to deal with the large burden of care, and social services are usually not equipped to supply adequate support for these people. As a result, patients find yourself trapped within the social safety net of a public hospital bed.
These beds often provide non-specialist care for dementia patients. An unfamiliar and over-stimulating environment, coupled with staff who may misinterpret the behavior of those patients, only makes difficult behavior worseThis, in turn, makes it difficult for caregivers of older people to simply accept such an individual.
There are currently anecdotally 50 to 70 patients in South Africa with symptoms suggestive of dementia who’re stuck in hospital, with no pressing medical reason to be there, waiting for a spot where they could be safely discharged, similar to aged care. In our experience, the common length of stay for these patients is 50 to 60 days and contributes to bottlenecks within the ED. These numbers will only increase because the population ages.
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A stand-alone dementia hospital could link the states and the Commonwealth in caring for people with behavioral and psychological symptoms of dementia. It cannot replace residential care for older people, but it could help the transition by improving the hospital experience for people with special age-related needs.
However, it is essential to take care of existing multidisciplinary approaches, similar to geriatric assessment and management services, to avoid isolating or separating care from those that are already vulnerable.
Improving existing hospitals for the elderly
While there could also be some justification for the decision for stand-alone geriatric hospitals, ultimately it is a signal of Australia’s failure to supply adequate and integrated hospital and aged care.
Commonwealth Government recently announced significant changes to funding for older people’s care and latest support for home care. Existing hospital services will surely work higher if patients had more options to which they may very well be referred after their hospital stay.
Upcoming Commonwealth Aged Care Act is expected to reform many points of care for older Australians. However, without further detail and collaboration between the federal government and the states and territories, integrated service planning is impossible.
In the meantime, existing hospitals could begin to rework into places which can be higher adapted to the needs of older people.