Health

1
Health Aged CareWhat is the common ground?

• Paul Sadler, CEO
• Aged Community Services Association of NSW ACT

ACHSE NSW State Conference, Sydney, April 2005
2
ACS NSW ACT

• ACS
• Largest peak body in aged community care
• 300 members over 1500 services
• Residential care community care retirement
  living
• Work with other peaks
• Aged Care Industry Council with ANHECA (NSW)
• Community Care Industry Council with 9 other
  groups

3
Common Ground

• Older People - Patients / Clients
• Age profile
• Impact of chronic disease
• Service usage patterns
• Dubbo Study 1988 to 2002
• 93 hospital admissions
• 15 residential care admission
• 30 of people 70 use community care services
• Workforce
• Types of staff
• Recruitment and retention challenges

4
Common Ground

• Care overlap
• Primary and community care
• Intake and comprehensive assessment
• Community health
• Acute / aged care interface
• Post acute care / slow stream rehabilitation
• Hospital in the home / nursing home
• Palliative care
• Nursing home placement

5
Common Ground

• Care overlap (cont.)
• Mental health of older people
• Rural services
• Multi-Purpose Services
• Funding and planning reform
• National Health Aged Care Reform
• Intersections with disability, housing

6
Differences

• Aged Care Whole of Life Focus
• Provision of long-term care
• Accommodation and care package
• Increasing focus on community care provision
• Quality of life emphasis
• Involvement in community
• Health Care Disease Management Focus
• Episodic care
• Acute, sub-acute and community delivery
• Disease management emphasis
• Medical and allied health specialities

7
Aged Community CarePolicy Drivers

• Review of Residential Aged Care Pricing
  Arrangements (Hogan Report)
• Funding, planning and accountability changes
• Industry efficiencies and consolidation
• Community Care Review (The Way Forward)
• Eligibility assessment tiered service
  delivery planning accountability fees
• Tendering and streamlining
• Interaction with health major issue for both
  reviews

8
Key Challenges /Opportunities

• Chronic disease growth with an ageing population
• Planning of service infrastructure
• Client / patient assessment and common records
• Service delivery models
• Workforce
• National health aged care reform

9
Growth in Chronic Diseases

• Growth projections
• Disabling conditions
• Mental health and physical
• Dementia
• 2005 - 200,000 by 2050 - 730,000
• Parkinsons Disease
• 2002 108,000 by 2020 250,000
• Opportunities
• National State Dementia Strategies
• Expand coverage of psychogeriatric services
• Use CADE funds to achieve this
• Increase emphasis on healthy ageing programs

10
Planning Service Infrastructure

• Issues
• Planning processes dont interact
• Health services planned separately from aged care
• Federal aged care planning ratios take no account
  of HACC or other State programs
• Bed blockers or bed vacancies result
• Historic problems of older people awaiting
  residential care placement in hospitals
• Recent emergence of high levels of residential
  care vacancies in some areas

11
Planning Service Infrastructure

• Issues (cont.)
• Failure to take opportunities for physical
  co-locations / partnerships
• Problems exacerbated in rural areas
• MPS developments
• AHS management supported in communities with no
  aged care homes
• Legal and capacity limitations on acute services
  management by aged care providers

12
Planning Service Infrastructure

• Opportunities
• Joint planning at State and Regional level
• Revision of aged and community care planning
  ratios
• Must take account of transitional care resources
• Co-locations and other partnerships with shared
  administrative and care staff, especially in
  rural areas
• Private and public sector potential

13
Client Assessment Records

• Issues
• Health and aged community care initiatives on
  intake and assessment poorly linked in NSW
• Personal Health Record e-health record
• Enhanced Primary Care MBS items
• Community care intake and comprehensive
  assessment (Ongoing Needs Identification - ONI)
• Aged Care Funding Instrument - ACFI (replacement
  for Resident Classification Scale)
• Role of ACATs unclear

14
Client Assessment Records

• Opportunities
• Integrate e-health record and ONI/ACFI
  developments
• Potential role of Better Service Delivery Program
  on-line platform
• Involvement of private health sector as well
• Combine HACC and Health funding to trial new
  systems
• Closer integration of EPC items with State
  initiatives

15
Service Delivery Models

• Issues
• Much good work in recent years, not generalised
  across whole of system
• Post acute care
• Transitional care / innovative care pilots
  ComPacks
• Hospital in the nursing home
• Palliative care
• ASSETs in emergency departments
• Nursing home placement
• Community care / community health interface
  affected by split responsibilities between DADHC
  and NSW Health for HACC

16
Service Delivery Models

• Opportunities
• Implement transitional care / slow stream
  rehabilitation programs in all AHSs in
  cooperation with aged care services
• Expand post acute community care via HACC and
  ComPacks
• Trial further hospital in the nursing home and
  palliative care services in residential care
• Fund and implement effective nursing home
  placement services across all AHSs
• Include private health sector in future
  developments

17
Workforce

• Issues
• Competition for scare resources rather than
  cooperation
• Spiralling award increases
• NSW Health policies restricting access to
  training for aged care workers (especially ENs)
• Rare examples of effective sharing of workers /
  training opportunities
• Most often in rural areas
• Opportunities
• Joint workforce planning at State and AHS level
• Organisational partnerships at ground level

18
National Health Aged Care Reform

• Issues
• Commonwealth resistant to fundamental reform
• Podger review
• HACC Agreement renegotiation
• Little involvement of aged care perspective in
  NSW position on any system reforms
• Opportunities
• Formal involvement of aged care peaks in
  consultations with NSW Government
• Negotiated inclusion of aged and community care
  services in new pilots

19
Cooperation to Date

• ACS has been encouraged by involvement of aged
  and community care representatives in Statewide
  forums recently
• Care of Older People Dementia Mental Health
• NSW Nursing Homes Act repeal very welcome
• Key challenge is now to make this happen at AHS
  level as new Area structures bed down

20
Where to Now?

• Make the health of older people a priority
• Work with aged and community care providers at
  regional and local levels
• Stay involved with ACS and other peaks at State
  and national level
• After all, health and aged care are too important
  to leave it up to the politicians!