I t Integrated Care for t d C f Older People with Older People - - PowerPoint PPT Presentation

I t t d C f Integrated Care for Older People with Older People with Complex Health Needs

Project Initiation

Project Team ACI 6 May 2013

Presentation Contents Presentation Contents

1 The Project

• 1. The Project
• 2. Next Steps

Why this project? Why this project?

• 1. Executive Leadership identified this area

i it as a priority

• 2. Increasing utilisation of services by Older

People:

• 53% of total bed days
• Double the average LOS
• 3. There has been significant work and
• 3. There has been significant work and

funding in this area – ‘Connecting the dots’ dots

The Vision The Vision

Older people and their carers/families in Older people and their carers/families in NSW, as partners in their care, are able to access appropriate, quality, evidence access appropriate, quality, evidence based healthcare that is provided in a timely, equitable and co-ordinated timely, equitable and co ordinated manner and delivered at home or as safely as close to home as is possible safely as close to home as is possible

Project Objectives Project Objectives

 Older People will have equitable and timely access to effective and appropriate hospital and community-based services  To improve the effectiveness and utilisation of current models of care T d l th f t f ld l  To reduce average length of stay for older people without an increase in readmission rates  To reduce avoidable admissions for older people  To reduce avoidable admissions for older people

(A program logic model will be developed to define these as measurable objectives) (A program logic model will be developed to define these as measurable objectives)

Definitions Definitions

• An older person (>65yrs) with complex health needs is one whose

d l i biditi d i di id l i t h di t underlying co-morbidities and individual circumstances have a direct impact on their ability to function and maintain independence on a daily basis.

• An integrated system approach to the support and management of

ld l k t i ti b i t i d

• lder people seeks to remove existing barriers to service access and

to tackle the discriminatory effects of cumbersome complicated patterns of service provision. (Framework for integrated support and

management of older people in the NSW health care system 2004-2006 page 15) management of older people in the NSW health care system 2004 2006, page 15)

Project Scope Project Scope

IN OUT

 Healthcare services provided to the complex older person that are funded by DoHA, DVA, NSW Ministry Health and Local Health Districts  Development of new models of care and clinical y , , y (including Justice Health), FACS (Office of Aging and ADHC),Guardianship Tribunal.  The interface with non-government Residential Aged Care Facilities (RACF) and care provided within RACF by NSW Health staff guidelines  Care provided within a non-government RACF by staff not employed by ( ) p y  Health Services delivered in primary, acute, subacute, ambulatory care, community/home based care, State Government Residential Aged Care Facilities, Multipurpose Services and via telehealth and outreach.  Services provided in metropolitan, regional, rural and remote settings staff not employed by NSW Health  Care provided within Private Hospitals and p p , g , g  Interface with General Practice and Medicare Locals and care provided within General Practice and Medical Locals by NSW Health staff  Interface with private healthcare providers and care provided within private healthcare providers by NSW Health staff clinics  Interstate care p p y  Interface with Specialist Mental Health Services for Older People, Ambulance Service of NSW, rehabilitation services, palliative care, Chronic Disease Management Services and cross border services.  Identification of best practice and new models of care, service gaps p , g p

2 N t St

• 2. Next Steps

Process for development Process for development

Completed by 30th June Completed by 30th September

Diagnostic Project Initiation

Completed by 30th September

Solution Design

Implementation 2013 2014 Now

Diagnostic Phase Diagnostic Phase

 Literature  Review previous work  Gain an understanding of current care and service provision by consulting with:

▲ 10 LHDs across NSW ▲ 8 Medicare Locals ▲ Patients, Consumers and Carers ▲ Residential Aged Care Facilities ▲ Residential Aged Care Facilities ▲ Ambulance Service of NSW ▲ ACI Networks ▲ ACI Networks

How we will work together... How we will work together...

From us:  Regular two-way communication  Provide opportunities to provide input on documents  Inform solution development From you:  Understanding of current programs being delivered  Facilitate visits (if required)

C t t Contacts

Chris Ball

Implementation Manager 9464 4656

Glen Pang

Network Manager 9464 4656 chris.ball@aci.health.nsw.gov.au 9464 4630 glen.pang@aci.health.nsw.gov.au

Level 4, Sage Building 67 Albert Avenue, Chatswood NSW 2067 PO Box 699 Chatswood NSW 2057 T + 61 2 9464 4666 F + 61 2 9464 4728 info@aci.health.nsw.gov.au www.aci.health.nsw.gov.au