From Hospital to Home The journey of people stuck in the system. - - PowerPoint PPT Presentation

From Hospital to Home

The journey of people stuck in the system.

Shane Jamieson – Youngcare Connect Manager Michelle Goding – Occupational Therapist, SDA Project, MNHHS

Introduction

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Metro North Hospital and Health Service

Background – Metro North Hospital and Health Service (MNHHS)

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Background – MNHHS – Fast Facts

Metro North Hospital and Health Service, 2017–2018 Annual Report, www.metronorth.health.qld.gov.au

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Staff 15,781 (MOHRI FTE) Investment in care $2.758 billion Sites 5 hospitals with 2,286 available beds, 15 community service locations, 27 oral health facilities and 15 mental health facilities Hospital admissions 283,368 people admitted Ambulance arrivals 103,018 ambulance arrivals handled by our emergency departments Emergency 291,846 attendances Outpatient services 1,367,662 outpatient occasions of service Surgical operations 50,032 elective and emergency operations performed Children 23,324 children under age 18 were admitted to Metro North wards and units Births 8,243 babies born at our facilities Mental health 406,150 contacts Community health 147,163 hours of direct primary care X-ray and ultrasound 300,333 x-ray and ultrasound attendances Dental 770,332 weighted occasions of service Breastscreens 43,031 breastscreens performed

https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2018/5618T1697.pdf

SDA Project Role

Objective -To achieve best possible housing outcomes for MNHHS NDIS participants.

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56 60 56 49 10 20 30 40 50 60 70 July to September 2018 October to December 2018

MNHHS ACAT – U65

Referrals Received Assessments Completed

2017 MNHHS Census Long-Stay Younger People with Disability

Facility Type Number of People Percentage % Comparison to 2016 Census data

Acute 8 3 8 Extended Care Facility 78 31.5 88 Residential Aged Facility 22 9 19 Mental Health 49 20 39 Community Care Units – Mental Health 54 21.5 50 Extended Care Facility – Mental Health 38 15 9

Within Metro North HHS, 249 people were identified in the 2017 census in the facilities list in Table 1 142 (57.26%) of records reported in the 2016 census were reported again in the 2017 census.

TOTAL MNHHS 249 people 100% 213 people (17% increase)

• Linking with NDIA to establish a SDA process for eligibility report/

proforma submission and approval.

• Completing SDA eligibility reports.
• NDIS pre-planning support – identifying information to build the case for

best possible plan e.g. OT home visit report to evidence need for complex home modifications in 1st plan.

• Linking with NDIS Planners to achieve optimal housing outcomes.
• Service provider/ housing provider contact.
• Advice/ support to clinicians for “long-stay” patients re: NDIS/ SDA.
• Family support through NDIS/ SDA process.

SDA Project Role

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Case Study - Melanie

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Case Study – Melanie

SDA project role:

• support provided to hospital OT to gather the clinical records (evidence) required

to complete the SDA report/ panel proforma;

• draft report completed;
• phone review of report completed with OT;
• Melanie was supported by hospital OT to visit SDA – Improved Liveability – unit

– single dwelling.

• SDA report/ proforma submitted.

Outcomes:

• Identification of accommodation options – application submitted to SDA provider

– offer to be made pending SDA approval outcome.

• Fast-tracked process to prevent admission RACF. Improve patient flow through

acute facility.

• Client focused, goal directed approach.

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Outcomes:

28 22 2 5 10 15 20 25 30 October 2018 to March 2019

SDA SUBMITTED VS. APPROVALS

SDA ready for submission SDA reports submitted SDA approved

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9 1 2 6 44 5 10 15 20 25 30 35 40 45 50

MNHHS SDA PROJECT NDIS PARTICIPANT HOUSING OUTCOMES

Inpatient (Exploring Housing Options) Home/ Complex Home Mods RACF SDA SSA/ SIL

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Outcomes:

• Building connections with MNHHS clinicians for NDIS

planning, including SDA.

• Submitting SDA reports/ proformas for long stay patients

across MNHHS.

• Networking/ planning with clinicians to explore housing
• ptions and the SDA report/ proforma writing processes.
• Established working contacts within NDIA re: SDA

approvals/ processes.

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Challenges/ Risks:

• Process for SDA approval.
• NDIS participants may accept SIL accommodation (not SDA

approved).

• NDIS Support Coordination process vs. MNHHS discharge

process.

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Conclusion - Where to next?

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• Continue to follow up SDA approvals for MNHHS

participants.

• Ongoing linking of participants to accommodation options

best suited to their support needs.

• Provide SDA and NDIS planning education and resources to

MNHHS clinicians to improve quality of NDIS plan and SDA

• utcomes.
• Develop a SDA pathway for MNHHS NDIS participants.
• Explore opportunities/ benefits of partnership model across
• ther hospital and health services within Australia.