Utilising residential aged care facilities for sub acute nursing care

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The average cost of an overnight stay in an Australian hospital is an interesting figure to find, in fact a very difficult one. I understand that with the large variances in hospitals, especially those in rural and remote areas, costs vary, however there is not an actual dollar figure. In 2010 the Productivity Commission quoted a national figure of $1117. With healthcare costs increasing one can assume that in 2014 this figure is well over $1200.

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While this figure accommodates acute services it is obvious that those requiring ongoing hospitalisation with a sub-acute condition, for example uncomplicated post-surgical recovery, could be provided quality care for significantly less by a residential aged care facility. Within a residential aged care facility a fully funded (concession) resident with the most complex healthcare needs, receives just under $200 per day for accommodation and care.
Transition care for older Australians operates under the Commonwealth Department of Health’s Transition Care program, managed by state health systems. This program has not been as successful as it could have due to rigorous criteria and the middle management of the state health system. I believe that nursing and accommodation services of residential aged care facilities are largely an untapped resource that have the potential to offer sub-acute care to patients of any age, not simply those eligible for residential aged care.
As older Australians stay in their homes longer it is obvious that they are entering residential aged care with higher acuity. As such, residential aged care providers are delivering a genuine sub-acute service that has the capacity to provide nursing and personal care to patients who fit within that classification.
I am aware of discrete arrangements between hospitals and aged care facilities across the county. I understand that on a local level these programs have been successful and that the benefits have been mutual.  Operationally, aged care providers are able to keep their occupancy rates high and public hospitals are able to deliver continued care services at a significantly reduced rate.
Patients remain admitted under the receiving hospital and are under the care of a General Practitioner (GP) agreeable to the admitting hospital.  The aged care facility provides nursing care while keeping clinical notes consistent with the requirements of the admitting hospital and accommodation appropriate to the client need.  The hospital provides an outreach service on an agreed periodic timeframe, with visits from a GP as required.
While these discrete local arrangements are visionary and are to be commended, a national approach could yield significant savings to the health budget. With 253,000 care beds in over 4000 facilities across the country the aged care industry has capacity to provide sub-acute nursing care and accommodation.  With occupancy averaging around 94 per cent across Australia it is possible that almost 15,000 bed days are available for hospital usage. Harnessing this approach could prove an innovative method to recruitment and retention for providers who are currently unable to compete with nursing wages in the acute sector.
The flow on benefits of full utilisation of aged care services are considerable.  Greater occasions of service provide greater attractiveness to secure visiting GPs, countering a current conundrum that often sees aged care residents enduring lengthy waits to see a GP.
The industry has seen some great examples of integrated living in the last year. Australian Unity has established Rathdowne Place a facility in Carlton, a suburb close to Melbourne’s CBD.  Rathdowne Place offers a fully integrated homecare, independent living and residential aged care service.  The facility boasts an on-site GP Super Clinic incorporating allied health services such as physiotherapy, occupational therapy, hydrotherapy and on-site pathology and diagnostic imaging.
Utilising the existing structures and services within residential aged care facilities for non-aged sub-acute patients makes good economic sense and provides an additional income stream that in turn has the ability to further develop care and services of residents and temporary patients.  Considering the current fiscal environment and over a decade of policy discouraging acute admission this is something that should be considered as a national health policy priority.

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“ I believe that nursing and accommodation services of residential aged care facilities  are largely an untapped resource that have the potential to offer sub-acute care to patients of any age, not simply those eligible for residential aged care.”  
PATRICK REID

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Patrick Reid
Patrick Reid is the CEO of Leading Age Services Australia.
Leading Age Services Australia
P 02 6230 1676
W  lasa.asn.au