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Aged Care Service Models

Older people require emergency care more often than other populations. They have longer Emergency Department (ED) length of stay and higher admission and readmission rates. Older people account for greater than 60% of hospital admissions and are at risk from hospitalisation itself, particularly delirium. Older people who become acutely unwell in RACF are a considerable proportion of ED presentations. A number of studies have found that for certain disorders or comorbidities; effective treatment does not necessitate presentation to ED from the RACF. For example, those with acute infections treated in their residence have similar or better survival and fewer complications compared to those transferred to hospital for treatment, even accounting for severity.

These aged care service models aim to improve emergency care for people living in RACFs through dedicated services in the form of support, guidance, direction and collaboration, which often includes virtual care methods, led by an experienced aged care nurse or medical practitioner, in partnership with allied health professionals.

The Agency for Clinical Innovation, Aged Health network also has a fantastic document outlining Aged health services model in NSW - click here

Aged Care Services Models aim to:

  • Improve care of older people within RACFs, where appropriate
  • Reduce ED presentation for patients from RACFs
  • Reduce hospital admissions for patients from RACFs
  • Reduce occupied bed days for patients from RACFs
  • Enable better communication systems between the ED, hospital and RACFs
  • Enhance integration of a range of services for older people to reduce ED presentations, eg. Hospital in the Home (HITH), General Practitioners and Primary Health Networks, In-reach/out-reach geriatric services.

Different aged care services models across NSW that pertain to emergency care include;

  • Aged Care Services Emergency Team (ASET)
  • Aged Emergency Care (ACE)
  • Geriatric Rapid Acute Care Evaluation (GRACE)
  • Aged Care Rapid Response Team (ARRT)
  • Health Care for Older Persons Earlier (HOPE-ED)
  • Geriatric Flying Squad (GFS)

Aged Emergency Care (ACE)

The Aged Care Emergency (ACE) Model of Care (MOC) is a nurse led integrated model of care that provides triage, consultancy, clinical support and advice for Residential Aged Care Facility (RACF) staff so that care for residents can be delivered in their facility, where appropriate, and unnecessary transfer to hospital is avoided. ACE was first piloted at John Hunter Hospital in 2010 and demonstrated a 35% reduction in occupied bed days and 16% reduction in ED presentations. The program was then piloted in 15 other sites. Resources for RACF can be found here. For further information and queries please contact: Rosslyn Barker - Aged Care Emergency (ACE) Clinical Nurse Consultant, (02) 4985 5549.

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