Aged care moving to community

More care will be offered to the elderly in the community under proposed changes to Otago District Health Board services which will begin in September.

At the end of August, the assessment treatment and rehabilitation day hospital service at Dunedin Hospital, known as the Gibson Rehabilitation Centre, will stop in its present form, although the Gibson Day Unit, which offers a day programme for elderly mental health patients, will continue.

Those attending the rehabilitation centre had been picked up and dropped off and given a meal on the day they attended, at a cost of $4 a patient. (Sometimes patients could be on the bus for two to four hours, a review of services stated.)Stopping this is expected to save the board about $100,000, although mental health and community services group manager Elaine Chisnall said some of that money would be redirected into providing care in the community.

Last financial year's figures showed the Gibson Day Unit hospital expenses were below expenditure by $47,000, but the assessment and rehabilitation centre was $238,376 in the red.

Mrs Chisnall said the proposed changes were not chosen because they would save money, but because it was considered the existing services were not fully meeting the needs of the elderly and that a more community-oriented approach was preferable.

Mrs Chisnall said research indicated people benefited from receiving rehabilitation services in their own environment rather than travelling to a hospital.

The current service, which had been running on its present site for at least 10 years, was out of step with modern practices which were geared to integrating hospital and community care.

Among the issues with the existing service was a high rate of people not attending because they did not understand why they should, the cost of providing the service was costing significantly more than the revenue received, services were duplicated for some patients, and some rehabilitation lacked goals for those attending.

Under the proposed arrangement, an inter-professional clinic would continue to be based at the hospital, offering limited places for people requiring comprehensive outpatient assessment on four afternoons a week.

The existing day hospital caters for 75 appointments a week.

There would also be a community-based rehabilitation service offering services - physiotherapy, speech language therapy, occupational therapy, for instance - to rehabilitate people in their homes.

This will involve the staff who work at the clinic still being run at the hospital.

In addition there will be an early response team, led by an experienced aged care registered nurse, who will provide a same day response to those people who are referred by their doctors as needing assessment and early intervention.

The aim of this is to prevent hospital admissions and provide the help required so people could remain in their own homes or a residential aged care home.

It was hoped that eventually a nurse practitioner with a specialty in aged care could be appointed to lead this service. This would complement the work of nurse practitioner specialising in psychiatric care of the elderly, Liz Langer, who was appointed in 2007, which has been successful in reducing hospital admissions.

Mrs Chisnall said the changes would involve increased collaboration with community health care providers.

The review began in May last year and is expected to be implemented over the next year.

Staff working in the day hospital will be redeployed to work under the new arrangements.

One of the concerns raised in feedback on the review was a proposal to discontinue transport to the mental health patients using the Gibson Day Unit and it was decided that transport should continue for those who could not access alternatives.

Meals will also only be provided for the mental health patients if they are attending a session which occurs over the usual midday meal time.

Day hospital services for over 65s

•From August 31, the Gibson Rehabilitation Centre at Dunedin Hospital will close, replaced by:

•A community-based rehabilitation service offering home assessment.

•An inter-professional clinic at the hospital on four afternoons a week. (Transport and meals will not be provided for this).

•An early response team aimed at preventing acute hospital admissions.

•The Gibson Day Unit for mental health patients will continue.

•Transport will continue to be provided to this for patients who cannot access alternatives.

•Meals will also be provided in the Gibson Day Unit if session runs over a lunchtime.


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