Complex Care Andrea Barry IPAC NUM September 2019 Health - PowerPoint PPT Presentation

Complex Care Andrea Barry IPAC NUM September 2019

Health Independence Programs (HIP) • Complex Care ( formerly HARP) – Care Coordination – Disability Hospital Passports and Action Plans • Post Acute Care • Residential In Reach

Referrals • Who can refer? – All health professionals, family, self. • 95% increase in referrals to Complex Care due to PAC, PFM and GP/Staff education compared to 5 years ago • Minimal referrals from other hospitals/ GP’s in the region despite awareness of program • Top 4 Diagnosis – COPD, Cardiac/CCF, Dementia, Pain • Av. Length on program – 8-16 weeks (longest 51 weeks) • Av. Home face to face visits weekly to fortnightly

What next? • No. of hospital admissions/ED presentations whilst on program • 68% had no presentations to ERH • 23% had 1-2 visits • 9% had 3 or more visits

Complex Care • Initial needs assessment – urgent referrals • Unravelling of information • Holistic approach • Health Literacy, Health Coaching • Home visits • GP Appointments with the client • Case study

Complex Care Outcomes • What does this mean to the client and family? • Key contact worker • Referral follow-up – ACAS, Specialists, Grants • 52% had ACAS referral • 15% clients linked to Homecare Packages • 28% Chronic disease plans developed – COPD, Cardiac , Asthma • 50% Allied Health Involvement • 34% Respiratory and Cardiac physician reviews • 48% of clients that were discharged from Complex Care were left on a Gov’t waitlist for ACAS, Commonwealth Home Care Package, NDIS, VCAT and HACC services.

Complex Care Outcomes • Commonwealth Homecare Packages Multiple packages at differing levels where accessed for the Echuca/Moama region • State Wide Acquired Brain Injury Funding- $2000 • Chronic Illness Funding • Regional Disability Support Initiative - $2000 • Elsie Murray Trustee Fund – children's education, equipment • A Start in Life funding up to age 25 - education • Queen’s Fund for childcare

Partnering with service provision • Commonwealth Assisted Continence Program • SWEP equipment funding – can take 2 years • MEPACS Alarms • Credit cards waived up to $10,000, Solar Panel waived $10,000 • Foxtel bills abolished • Medical cooling electricity rebates, new hot water service • Early entry to NDIS • Community Admissions to GEM • Parking permits • VPTAS – travel reimbursement for medical appt’s in Melbourne • Housing relocation – 8 required relocation • Advanced Care Directives and Powers of Attorney • Food Bank • DSP - $8000 back pay.

More outcomes • Commonwealth Assisted Continence Program • SWEP equipment funding – can take 2 years • MEPACS Alarms • Credit cards waived up to $10,000 • Foxtel bills abolished • Medical cooling electricity rebates • Early entry to NDIS • Community Admissions to GEM • Parking permits • VPTAS – travel reimbursement for medical appt’s in Melbourne • Housing relocation – 8 required relocation • Advanced Care Directives and Powers of Attorney • Dental/ Optometry

Local partnering • Victims Assistance program – Anglicare • Neighbourhood house • Campaspe Library • Redgum centre – meals • Planned Activities Groups – Steps • Salvation Army – counselling service, white goods, blankets, clothes, Xmas presents • Camar – pet minding • Kids Undercover – housing • St.Kilda Mums – prem clothing, GV Pregnancy Support • Foodbank • Apex – gardening, firewood

Will you make a referral to Complex Care? • complexcare@erh.org.au • Ph: 54 855 855