08 September 2015

Guest Blog by Walter de Ruyter: Transfer of Care for Complex Health Consumers (Part 1)

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Baby Boomers as a demographic have defined every market as they have aged. A number of care providers in both acute and aged care liken the changes with consumer-directed care as an express train minutes away from leaving the station. These services are doing as much as possible to ensure they are on board and are the drivers of the care experience expected by this demographic. Complacency in this changing market will see many polishing their vintage trains and wondering why they have less and less passengers.
Changing transfer of care models and adapting to consumer expectations

The consumer’s expectations of care are changing with the following comment resonating with many;

“I was sick recently and needed to go to hospital. Staff were all caring but I felt like a widget on a production line. I will probably need to go to hospital again…there needs to be a better way?”  (Resident in aged care 2015).

This is in an environment where the expenditure of the health budgets are increasingly influenced or directly controlled by consumers and recognition by providers to move the rate of unplanned to planned episodes of care resulting in strong interest to evaluate transfer of care models.

As background to the changing expectations of consumers there is a growing trend towards social wellbeing through a model of change called collective impact to build capacity through networked community solutions.

This model focuses on the reorientation of physical and social capital for the benefit of local communities. A recent example is in the Queensland City of LoganTogether collective impact initiative a key project called: “City of Choice Two-Year Action Plan 2013-2015”. Logan Together aims to close the gap so that, by the age of eight, Logan children will be as healthy as any other group of Australian children and reach agreed health, education and social milestones[1].

The above will increasingly influence health and wellbeing models. The expectation of wellbeing in Logan children is mirrored in care expectations by baby boomers who have influenced every market as this consumer demographic ages. This expectation has significant implications for service providers as per the enclosed example for aged care. To learn more on future wellbeing models, please read this paper on Consumer Directed Care Social Inclusion & Wellbeing.

Social inclusion and wellbeing

Service funding is tied to key performance measures of care predominantly within the service and not between services. The consumer is seeking a seamless health and well-being experience where increments of care from a variety of providers are sequenced specific to their needs from entry to exit. In many services measures of process and practice between services are not evident, whilst many funding sources external to the provider do not ask for how well a consumer is transferred between care. Pathways are such a measure and we can ask ourselves how many pathways do services participate in that guides the journey of the consumer between multiple providers? 

The following conversation topics have a focus on building capacity through planned care at point of need.  A fundamental building block of collective impact strategies is networks which have an aligned focus. Two key elements are reorienting physical and social capital. An example of reorienting physical capital is addressing the question; each time an aged care resident occupies a hospital bed their aged care beds is empty? This suggests health does not have a bed problem with its hospitals; it has a service delivery opportunity.  

An example of reorienting social capital is the observation that it is cheaper to change staffing models than building new hospital beds. The Australian Federal Government has made changes recently to the classification of aged care beds by removing the distinction between high and low care to ageing in place. Regulations in NSW stipulate that ageing in place requires 24hr Registered Nurses cover, currently a subject of a current NSW Parliament enquiry. The present aged care funding model results in many small providers not having the capacity to generate enough income to cover wages for 24 hour registered nurses with the advent of this change to ageing in place. The question that can be asked; can the Aged Care Funding Instrument (ACFI) be changed to incentivize providers to employ Registered Nurses?
Part 2 of the Transfer of Care for Complex Health Consumers blog will look at introducing new funding models.
Walter de Ruyter will be speaking at our upcoming Transfer of Care for Complex Consumers Conference on 1-3rd December in Sydney.  

Walter de Ruyter comes to the aged care industry with background in health over the past 33 years. This has culminated in gaining experience across a range of vocational disciplines in nursing, midwifery and anaesthetics. The challenge is to provide services to ageing communities in a way that meets people's expectations. With the advent of consumer directed care these clients often do not see themselves as being old but just needing a hand to remain well and part of their community irrespective of where they live.

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