Why we need a co-design approach to transitionary care

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Assuming the necessary legislation is passed in time, in less than a year short term restorative care places are due to be incorporated into the aged care planning ratio, writes Patrick Reid.

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The 2015 Budget announcement of a progressive increase of short-term restorative care places was welcomed by LASA and its members, but this does not address existing gaps and flaws in current transitionary care processes.
If anything, the planned increase of 2,000 places by 2021 without a co-designed review of transitionary care will create additional burdens on local services and compromised quality of care.
By co-design I am referring not only to decision-makers within a given hospital, aged care facility and government department, but also patients/residents, their families, GPs, pharmacists, home care providers, paramedics, community nurses and carers, technology developers and IT gurus, universities and manufacturers. In other words, representatives from any sector or service provider that may come into contact with a person immediately before, during or after they transition from one care setting to another.
Taking a co-design approach to social services is relatively new to our way of thinking but its premise is simple: engaging users of products and services in the design process will lead to improvements and innovation.
In the UK, co-design has long been central to the creation of specific health services including the first children’s hospital built in the English-speaking world in 1852, the Great Ormond Street Hospital for Children. Today the hospital continues its innovative approach to medicine not only through clinical research and therapeutic firsts, but creative, co-designed approaches to the healing environment and hospital experience for patients, visitors and staff.
As a term, co-design has crept into the lexicon of policy makers, advisors and analysts and is actively lobbied as the best approach to improving many social services. British thinktank Demos recently identified co-design (sometimes also called co-production) as vital in supporting people with learning disabilities and mental illness, noting, “when co-production works best, people who use services and carers are valued by organisations as partners – they have the same influence over any decisions made about the service as anyone else.”
Social design agency thinkpublic helped to inform the UK’s 2008 National Dementia Strategy by gaining unique insight into living with dementia through teaching people with the disease how to interview people and use video recorders. The joint project with the Alzheimer’s Society fed directly into co-design workshops and resulted in a number of project proposals, including a Dementia Signposting Service, a Mentoring Programme for Carers and the design of a safe “Wandering Garden”.
Returning to Australia, and there are many lessons about the value and impact of a co-design approach to services in relation to transitionary care.
The increase of restorative care places ultimately aims to support older Australians to remain living at home longer. But simply increasing the number of places for transitionary care alone will not achieve this.
No matter the mode of transfer from acute care to home or residential aged care, the most important aspect of a person moving through the health and age services systems is that the journey be seamless.
A study published in 2008 found the transition between acute health care and residential aged care settings was impacted by four key factors: shortfalls in information and communication processes, cooperative care, and discharge planning procedures. In one submission to the National Health and Hospital Reform it was stated there is a perception that hospitals are desperate to get elderly people out of acute care, and some of the findings reported that prior to transfer from hospitals, aged care residents appear to suffer significantly from nutritional deficiencies, and compromised skin integrity.
While these are not recent reports, we do know that in 2012-13, patients who were waiting for residential aged care used 10.4 of 1,000 patient days nationally (for overnight separations only).
Despite having the capability to offer more complex health, wellbeing and re-ablement services, residential age service providers face myriad issues they need to consider when accepting a transfer from the acute hospital system.
The transition from one care setting to another can be upsetting for both the patient/resident and their family, and should occur with as much information as possible from the transferring acute service.
Service providers also have to consider important factors before accepting a person transferring from acute care that may impact on their ability to fulfil their duty of care from the person’s arrival. These include whether the person is being admitted on a respite or permanent basis, their medical history and current diagnoses, medication regime and family involvement, the capacity and capability of staff to meet the needs of the individual, cost of care and whether ACFI will cover ongoing costs, availability of appropriate clinical supervision and whether there will be a comprehensive handover.
As the voice of age services, LASA has called on the government to consult with the industry before making any changes to restorative care places. There are many areas in which the provision of age services can be improved through co-design and integration with other industries, and transitionary care could become the watershed.
It is only through taking a co-design approach to reviewing the current transfer of care processes and systems that we will be able to ensure a seamless journey for older Australians moving from acute to sub acute services, and remaining in their homes for as long as possible.

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References
1 Dr. Ingrid Burkett, Co-designing for Social Good: The Role of Citizens in Designing and Delivering Social Services, Part One - http://design4socialinnovation.com.au/wp-content/uploads/2014/09/An-Introduction-to-Co-Design-by-Ingrid-Burkett.pdf
2 Victoria Rugg - www.demos.co.uk/files/Future_of_Disability_-_web.pdf?1411454406
3 Improving resident transfers between hospital and residential aged care facilities www.bsl.org.au/.../MeesePoole_Improving_resident_ transfers_ 2008.pdf
4 Submission National Health and Hospital Reform www.health.gov.au/internet/nhhrc/publishing.nsf/Content/280/$ FILE/280%20-%20SUBMISSION%20%20Prof%20Tracey%20McDonald%20Individual%20Submission.pdf
Patrick Reid
Patrick Reid is the CEO of Leading Age Services Australia.
Leading Age Services
Australia
P 02 6230 1676
W lasa.asn.au
Thinkpublic founder, Deborah Szebeko, is a keynote speaker at LASA’s national congress in Melbourne from 11-14 October 2015. For more information go to www.lasacongress.asn.au