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

I t Integrated Care for t d C f Older People with Older People with Complex Health Needs Project Initiation Project Team 6 May 2013 ACI

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 as a priority i it 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  To reduce average length of stay for older people T d l th f t f ld l 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  underlying co-morbidities and individual circumstances have a direct d l i biditi d i di id l i t h di t impact on their ability to function and maintain independence on a daily basis.  An integrated system approach to the support and management of older people seeks to remove existing barriers to service access and ld l k t i ti b i t i d 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 management of older people in the NSW health care system 2004 2006, page 15) page 15)

Project Scope Project Scope IN OUT   Healthcare services provided to the complex older person that are Development of new funded by DoHA, DVA, NSW Ministry Health and Local Health Districts y , , y models of care and clinical (including Justice Health), FACS (Office of Aging and guidelines ADHC),Guardianship Tribunal.  Care provided within a  The interface with non-government Residential Aged Care Facilities non-government RACF by (RACF) and care provided within RACF by NSW Health staff ( ) p y staff not employed by staff not employed by  Health Services delivered in primary, acute, subacute, ambulatory care, NSW Health community/home based care, State Government Residential Aged  Care provided within Care Facilities, Multipurpose Services and via telehealth and outreach. Private Hospitals and  Services provided in metropolitan, regional, rural and remote settings p p , g , g clinics  Interface with General Practice and Medicare Locals and care provided  Interstate care 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 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. Next Steps t St 2 N

Process for development Process for development Completed by 30 th June Completed by 30 th September Completed by 30 th September Project Initiation Diagnostic 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 Contacts t t Chris Ball Glen Pang Implementation Manager Network Manager 9464 4656 9464 4656 9464 4630 chris.ball@aci.health.nsw.gov.au glen.pang@aci.health.nsw.gov.au Level 4, Sage Building PO Box 699 T + 61 2 9464 4666 info@aci.health.nsw.gov.au 67 Albert Avenue, Chatswood NSW 2067 Chatswood NSW 2057 F + 61 2 9464 4728 www.aci.health.nsw.gov.au